Revenue Cycle Specialist

2 months ago

State College, United States Mount Nittany Health Full time

Why Mount Nittany Health?:

At Mount Nittany Health, we provide high-quality patient care with a unique combination of the latest in clinical technology and compassionate medical professionals. We are committed to improving both the quality and availability of healthcare in our region and seek to hire only the best to support the communities we serve.

Overview:

The Revenue Cycle Specialist will assist in the development of a strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending and support the execution for a comprehensive claim accuracy program. The incumbent will optimize pre/post claim editing, auditing, and claim recovery programs that will drive incremental value year over year. The Revenue Cycle Specialist will employ use of analytics, trends, competitor benchmarking, and outcomes to continually identify savings opportunities, develop mitigation strategies to avoid future overpayments/underpayments, and implement plans to achieve business goals. The Revenue Cycle Specialist assists the Revenue Cycle Project manager with payor contracting, underpayment analysis, reimbursement audits and compliance, charge capture, pricing strategies. Ensures that all appropriate billing charges are being captured, documented, charged and reimbursed for the assigned department. Assists in planning and performing advanced price modeling activities for new or existing service lines. May perform special project assignments with respect to applicable regulations and the overall revenue cycle.

Qualifications:

Education:

1) High School graduate or equivalent with minimum of 3 years working in healthcare revenue cycle.
2) Graduate of an approved medical secretarial Associate Degree program preferred and / or minimum of 2 years working in healthcare revenue cycle.
3) Bachelors degree in Healthcare related business preferred.

Experience:

1) Relevant experience in a related position which has provided the applicant with strong working knowledge in HIPPA compliant coding, billing and payer relations.
2) Must have knowledge of the assigned third parties' billing requirements
Medicare, Medicaid, Blue Cross, Commercial, HMO, MVA, OVR, MH/MR, Worker's Compensation


Knowledge, Skills, Abilities:

1) Demonstrated proficiency in revenue cycle concepts, terms, definitions, and metrics
2) Familiarity with billing cycle including the ability to interpret EOBs and understanding of payment methodologies.
3) Ability to work independently and meet time-sensitive deadlines
4) Excellent organizational, multi-tasking, and time management skills with the ability to anticipate tasks and prioritize assignments.
5) Ability to draft professional correspondence, forms, and reports
6) Ability to deliver prepared information to the audience (mostly patients) in an easy-to-understand manner
7) Requires critical thinking skills, ability to make good decisions, listen and accept advice from others, demonstrate maturity and good judgment.
8) Promote/deliver excellent customer service to both internal (employees and management) and external customers (patients, auditors, and other third parties).
9) Demonstrating knowledge in HIPPA compliant ICD-10 CM Diagnosis and procedure codes, CPT-4 codes, billing HIPPA compliant claims electronically on standard hospital forms or (alternatively).
10) Must have working knowledge and proficiency in computer operation.
11) This individual must be able to work as a team member with job sharing. Good communication skills to initiate communication to Mount Nittany Health System staff and insurance professionals regarding charges, coding and diagnosis problems.
12) Must have an understanding of the UB04 and / or 1500 forms and the procedure for review of CPT 4 codes, combined batteries, HIV charges requirements to release information, and review of revenue codes for HCPCS entered by Medical Records following HIPPA compliant formatting.
13) Possess thorough knowledge of claims submission process.
14) Knowledge of specific medical and Health System billing applications, i.e., Medicare, Medical Assistance, Blue Cross Plans and HMOs is preferred.

License/Certification/Registration:

1) None required.

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