FT, Mon - Fri; 8:00 am - 5:00 pm Flexible (Professional Billing)
Were searching for a Billing Revenue Cycle Specialist to analyze system and payer issues that hinder claim processing and reimbursement. Coordinates with the Manager/Supervisor to research and identify root cause and develop and implement resolution for assigned area (hospital or professional services). When necessary, works with payer representatives to correct and resubmit affected claims for payment.
- Identifies and communicates trends in recurring denials resulting in need for process improvement or system edits to eliminate future denials for assigned area (hospital or professional services)
- Under the direction of the Manager/Supervisor, works with necessary departments (e.g., IT Resolution Team, Case Management, Authorizations) to drive process improvement and system edits.
- Research specific payer billing requirements to understand specific reasons for denials and preventable measures available.
- Maintain professional relationship with payer representatives to facilitate process improvement.
- Logs and monitors all tasks and projects on the Revenue Cycle Project List.
- Ensure all targets are attained and due dates as established by Revenue Cycle Leadership
- Work with IT and Analyst to measure financial impact and improvement is maintained.
- Work special projects assigned by Manager/Supervisor .
- Review and analyze claims and perform appropriate action for claim resolution.
KNOWLEDGE, SKILLS AND ABILITIES
- Knowledge of internal operations to facilitate appropriate revenue cycle management efforts and pricing of our services.
- Knowledge of hospital and professional billing, collection and reimbursement requirements and standard practice.
- Ability to review, interpret and understand managed care contracts with third-party payors.
- Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental programs and regulations.
- Knowledge of CPT, HCPCS and revenue codes and their effect on reimbursement.
- Ability to communicate effectively both verbally and in writing.
EDUCATION AND EXPERIENCE
- Associate degree from an accredited college or university in Information Systems, Business, Finance, or related field required. equivalent relevant work experience may be substituted for education.
- Minimum 3 years experience in Information Technology, Physicians billing or Hospital billing systems required
- Basic knowledge of Word, Excel, Access and PowerPoint required.
- Previous EPIC Experience preferred.
Make a meaningful difference improving the lives of children!
At Childrens, the regions only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring teamand join us in providing brighter, healthier tomorrows for the children we serve.