Revenue Optimization Specialist

2 weeks ago

Indianapolis, United States Pinnacle Healthcare Consulting LLC Full time
Job DescriptionJob Description

Job Title: RCM Revenue Optimization Specialist

Location: In Office

Required minimum years of experience: 5 – 7 years

Pay: Hourly $22 - $25

Competitive Benefits: Medical, Dental, Vision, STD, LTD, HSA (as applicable with Employer contribution), 401k Plan with employer match.

Welcome to Pinnacle Pinnacle Healthcare Revenue Solutions (PHRS) is a full Revenue Cycle Management (RCM) company focused on professional billing for independent physician practices. PHRS is a division of Pinnacle Healthcare, a growing healthcare consulting company based in Colorado with regional offices in St. Louis, Missouri, Indianapolis, Indiana, Phoenix, Arizona and remote employees in 25 states. We offer our employees a GREAT team environment, wonderful camaraderie among the team members, and a true appreciation and recognition for hard work.

PURPOSE AND SCOPE:

The purpose of this position is to support Pinnacle Healthcare Revenue Solutions’ mission, vision, core values and customer service philosophy.

Due to a high acumen experience and performance of all aspects of the revenue cycle, the RCM Revenue Optimization specialist is the highest level accounts receivable role and serves as the ‘subject matter expert’ of a designated client(s).


CUSTOMER SERVICE:

  • Accountable for outstanding customer service to all external and internal customers.
  • Develops and maintains effective relationships through effective and timely communication.
  • Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.


PRINCIPAL RESPONSIBILITIES AND DUTIES:

  • Is assigned AR responsibility as determined by the Director.
  • Identify and resolve problems and inconsistencies and recommend appropriate corrective procedures to resolve.
  • Functions as a liaison between upper management regarding revenue cycle issues.
  • Functions as a liaison between the client and associated client professional organizations, such as vendors, credentialing contacts, and other agencies as needed.
  • Is current on all payer bulletins and communicates pertinent information to staff, peers and management
  • Assist the Director in training material for all job functions, including PM system, payer portals, and any other internal and external resources required for the team to function at the highest level of proficiency.
  • Assist in training and/or instructs current and new employees in job duties or company policies or arrange for training to be provided.
  • Resolves customer complaints or answers customers’ questions regarding policies and procedures that escalate from any department associate.
  • Makes recommendations to upper management concerning such issues as staffing decisions or procedural changes.
  • As the assigned client expert, alerts the Director is a concern is identified regarding staff compliance of the organization’s confidentiality policy in accordance to the Health Insurance Portability and Accountability Act (HIPAA) regulations.
  • Completes all tasks assigned by the Director in a timely manner.
  • Communicates any issues to the Director for tasks or other performance related that will extend a deadline or adversely affect revenue.
  • Improve organizational performance by identifying opportunities for improvement in the revenue cycle process.
  • Participates/Directs assigned general administrative projects.

ESSENTIAL ROLE FUNCTIONS:

  • High level alertness for adverse activities or trends:
    1. Examples: (not exhaustive)
      • Accounts that are approaching timely filing
      • High level observation of Work-queue status that seems to be struggling
      • Payer changes; recoupments, down-coding, etc.
  • Awareness of denial trends and assist the Director with a process to redesign to reduce avoidable denials
    1. This may involve workflow recommendations to the client
  • Communicate non-covered services to the Director for research and policy development
  • Assists and provides feedback to the Director to assure customer service representatives (CSR) have access and training to perform task such as:
    1. Able to understand and articulate a payer’s explanation of benefits
    2. Explain copayment and deductibles
    3. Can accurately update patient demographics and insurance
    4. Are able to refile a claim (based on the complexity of the account and payer)


EDUCATION:

  • High School diploma or equivalent is required.
  • Associates Degree in Medical Billing and Coding or a related field is preferred.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

Employee must be able to sit at a desk for at least eight hours per day while frequently using their fingers to type. This position requires that the employee be able to speak clearly, look at and read a computer screen. Occasionally, this position may require that the employee reach or stretch for objects.

EXPERIENCE AND REQUIRED SKILLS:

  • 5-7 years of experience in medical billing office or related environment.
  • Must have a thorough understanding of the entire revenue cycle including: customer service, charge entry, cash applications, accounts receivable, credentialing and coding.
  • Candidate must understand government and managed care payment methodologies and demonstrate knowledge of terms such as contractual adjustment, allowed amount, coinsurance, denial and denial processes.
  • Proven knowledge and ability to apply ICD10 and CPT Coding is a must.
  • Knowledge and ability to stay abreast of HIPAA laws and regulations and maintain compliance
  • Attention to detail to ensure accuracy of information
  • Working knowledge of MS Suite skills including Excel, Word, and Outlook
  • Proven analytical skills
  • Ability to present, communicate initiatives, results and analyses to multiple levels of management and clients
  • Current working knowledge in medical professional claims processing, payment posting, collections and A/R Follow up

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