Claims Resolution Specialist Hybrid

GENERAL SUMMARY

The Claims Resolution Specialist is responsible for monitoring the charge capture process and identifying issues and process improvement opportunities within the Mid-Revenue Cycle. The position is responsible for revenue leakage root cause analysis and resolution recommendations. This role supports the revenue cycle workflows, charge capture, and work queue processes. This position will help optimize Revenue Cycle by evaluating, validating, and trending data for presentation to all levels of the organization. This role reports to the Coding Supervisor.

ESSENTIAL JOB FUNCTION/COMPETENCIES

• Monitors scheduling and revenue reports for all practice locations to ensure all charges are entered timely and appropriately according to charge capture policy standards
• Monitors practice adherence to charge reconciliation processes
• Works Missing Encounter Report to identify missing charges and ensure they are posted timely and accurately ? Runs surgery schedule weekly and monthly to ensure all scheduled surgeries and related charges have been billed
• Monitors late charges and write-offs by reviewing reports weekly to determine root causes for late charges
• Maintains charge screens and department charge master files ? Provides feedback to Coding & Revenue Integrity Manager on consistent basis for those providers/clinicians/practices that are not meeting charge entry standard
• Performs quantitative and financial analysis from daily audit findings as it pertains to charge capture
• Provides estimated revenue impact from audit findings to leadership
• Works with Revenue Integrity Team, Clinical Operations and RCM (Revenue Cycle Management) staff to implement corrective actions to ensure compliant charges, prevent future rejections/denials and accurate and reimbursement
• Responds to queries regarding charges
• Participates in ongoing coordination and resolution of revenue issues as they arise.
• Assists in troubleshooting and resolving issues related to the patient mid-revenue cycle and assists in development and recommendations Job may require other duties as assigned

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

Coding and/or Physician Billing Certification, preferred

KNOWLEDGE | SKILLS | ABILITIES

Demonstrates understanding of business and how actions contribute to company performance

Demonstrates excellent customer service skills

Knowledge of medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD) coding, and the entire revenue cycle process

Knowledge of EHR (Electronic Health Record) software systems and Microsoft Office products

Professional verbal and written communication skills

Ability to develop reports and create presentations

Ability to work collaboratively across disciplines and business lines

Must be comfortable educating staff members

Ability to handle multiple tasks with excellent problem-solving skills

Strong analytical skills with ability to make conclusions and recommendations

Well organized with the ability to maintain accuracy and confidentiality

EDUCATION REQUIREMENTS

High school diploma or general education degree (GED); or equivalent combination of education and experience.

EXPERIENCE REQUIREMENTS

Minimum of one years’ revenue cycle experience within a physician practice

Minimum of one years’ AR experience within a physician practice

Experience in Urology or physician practice environment preferred