Senior Specialist, Revenue Cycle Commercial

We are recruiting for a motivated Senior Specialist, Revenue Cycle Commercial to join our team!

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Department

Billing and Collections

Job Summary

The Revenue Cycle Specialist Senior works under general supervision. This incumbent provides financial, clerical, and administrative services to ensure efficient, timely and accurate reimbursement of all inpatient/ outpatient hospital and physician claims submitted by Hospital and Physician Services. The incumbent corresponds with insurance companies, patients, guarantors, providers, attorneys, and other partners to resolve unpaid balances in a timely manner. Delivers customer service, billing, follow-up, cash application processes, reconciliation of payer remittances, denial management and appeal functions. Provides financial guidance on self-pay accounts. Investigates delinquent accounts for legal liability. This role requires exceptional knowledge of insurance rules, payor specific guidelines, regulatory requirements, claim submission, processing, and collections. Individuals in this role must possess strong attention to detail and excellent communication skills, both verbally and in writing. This position requires an individual that can correspond professionally and competently on escalated issues/concerns, as well as higher level detailed situations. This role serves as a resource and mentor for junior members. Assists in leading and openly supporting management in projects, training, and organizational initiatives to achieve departmental and cash goals.

Essential Functions:

• Maintain detailed knowledge of revenue cycle functions and metrics. Work accounts receivables to ensure timely payments from insurance and/or patients. Initiates claims submissions, performs review of accounts, ensures work performed is accurate and complete. Documents contact with patients, guarantors, insurance companies and others using the appropriate methods. Identify trends, conduct follow-up, and perform root cause analysis on unpaid and underpaid accounts. (50%)
• Trains staff, responds to inquiries and complex questions and collaborates with Supervisor to develop training material and standard of work for the department. Builds trusting relationships with internal and external departments/ business partners by providing confident leadership and timely communication. (20%)
• Completes worklists and/or reports as assigned. Performs deep-dive analysis of KPI’s, identify underlying drivers, uncovers new insights, and makes data-driven recommendations to stakeholders which results in improved business and performance. (15%)
• Utilizes various payer systems, provider portals, and internal applications. (10%)
• Reviews websites, bulletins, etc., to keep current knowledge of regulatory requirements. Relays updated information to key stakeholders regarding policy changes. (5%)

Education:

• High School Diploma or GED Required

Work Experience:

• 4-6 years Four years minimum of hospital/ medical office experience, with an emphasis on claim submission, insurance follow up, insurance denials and credit balances. Required

Licenses:

Knowledge, Skills and Abilities:

• Intermediate knowledge of insurance billing, insurance processing and practices, payor rules and regulations related to claim processing and applicable insurance definitions.
• Must have strong written and verbal communication skills, analytical thinking, high level of computer accuracy, and organization and problem solving skills.
• Ability to prioritize work activities with minimal supervision in an individual and team setting.
• Ability to utilize various software applications and information systems to perform work processes.
• Working knowledge of accounts receivable databases. Skill sets to include 10-key by touch and typing a minimum of 35 words per minute (WPM).
• Attention to detail and ability to demonstrate professional work behavior.

Shift

Days (United States of America)

Work Type

Regular

Salary

$23.97 - $35.96 / hr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes