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Revenue Cycle Specialist IV
2 months ago
What you will be doing in this role:
Under general supervision and following established practices, policies, and guidelines, outpatient billing and collections support, performing duties which may include reviewing and submitting claims to third party payors, performing account follow-up activities, updating information on account, etc. Positions at this level require expert knowledge, skill and proficiency in specialized functions and multiple areas of the revenue cycle. Incumbents have expert knowledge and understanding of regulatory requirements, payor contracts and CSHS policies governing billing and collections and sound interpretation of same. Incumbents are expected to research, analyze and resolve complex cases and problem accounts with minimal assistance. Serves as a technical resource (subject matter expert) to others and may act in the absence of the lead and/or supervisor. This position may be cross-trained in other revenue cycle functions and provide back-up coverage:
- Independently responds timely and accurately to all requests. Interacts professionally and courteously with employees and internal and external customers.
- Effectively communicates, in writing and verbally, with employees and internal and external customers. Actively participates in department meetings and provides feedback to management on how to improve department processes. Adheres to instructions, verbal and written, to achieve desired results. Assists supervisors in composing policy and procedure manuals and statements for the department. Communication is clear and easy to understand. Thoughts are coherent and logical. Written communication (email, etc.) is appropriate for level being addressed.
- Effectively manages time. Maintains a clean and orderly workstation. Prioritizes work activities consistent with department goals and can balance daily workload and several projects.
- Exemplifies high standards of professionalism, responsibility, accountability and ethical behavior. Participates in continuing education activities and promotes a positive and productive working environment. Engages in performance improvement activities within the department. Able to multi-task effectively and is flexible with priorities. Adapts and modifies practices and routines when advised of need to do so, with a positive attitude. Takes initiative independently. Self-directed and rarely needs to consult management or co-workers. Volunteers and accepts special projects and assignments.
- Applies detailed knowledge of and follows all hospital and department policies, procedures (e.g., PHI). department specific systems and uses them effectively and efficiently. Participants in ongoing education to improve skill.
- Effectively monitors assigned work queues and workload, ensuring resolve of accounts in a timely and accurate manner. Manages workload and priorities to meet deadlines. Takes initiative on issues and/or problems achieving desired results with minimal instruction. Notifies supervisor of issues and/or problems outside scope of authority per department standard.
- Understands and follows all applicable job aids and processes for unit. Applies "TCR" Touch It, Claim It, Resolve It.
- Adheres to documentation standards of the department. Properly uses activity codes. Notes are clear and concise. Correctly enters data in fields. Maintains acceptable levels of speed and accuracy.
- Demonstrates expert knowledge of payor practices, policies and procedures as well as the initiative and ability to problem solve in accomplishing departmental objectives. Monitors payment status of assigned accounts. Independently initiates dialogue with payor and/or patient to ensure resolution of accounts (e.g., responds to additional documentation requests, refers denied accounts to supervisor for advisement on appropriate action). Effectively and efficiently manages account inventory and ensures timely resolution and closure of accounts
Requirements:
- A minimum of five years of professional billing or collection experience required.
- Active CPC highly preferred. A minimum of 5 years of professional coding highly preferred.
- High school diploma or GED required. College level courses in finance, business or health insurance preferred.
- Strong English proficiency, including using proper spelling and grammar, and solid verbal communication skills.
- Business math skills including ability to add, subtract, multiply and divide accurately.
