Revenue Cycle Specialist

1 month ago

Buffalo, United States Seneca Holdings LLC Full time

Western Door Federal is part of the Seneca Nation Group (SNG) portfolio of companies. SNG is the federal government contracting business wholly owned by the Seneca Nation. SNG meets mission-critical needs of federal civilian, defense, and intelligence community customers across a variety of domains. The SNG portfolio receives shared services support from its parent company Seneca Holdings and is comprised of multiple companies that participate in the Small Business Administration 8(a) program. To learn more visit www.senecanationgroup.com and follow us on LinkedIn.

The Seneca Nation Group companies offer competitive compensation and a strong benefits package including comprehensive medical and dental care, matching 401K, paid time off, flexible spending accounts, disability coverage, and other benefits that help provide financial protection for you and your family. We pride ourselves on our collaborative work environment and culture which embraces our mission of providing financial and non-financial benefits back to the members of the Seneca Nation.

Western Door Federalis seeking a Revenue Cycle Specialist in the continental US (remote authorized) to support the Defense Health Agency. The objective of this work is to assist our government healthcare client to develop and implement a Revenue Integrity program and operations.

Roles and Responsibilities include but are not limited to:

  • Support the DHA-project with extensive SME (Subject Matter Expert) knowledge in MHS GENESIS Revenue Cycle including all Charge Services.
  • Supports the system's ability to provide integrated solutions and services to optimize business workflows, and control cost to collect across acute, ambulatory, specialty, and inpatient venues.
  • Support an assessment of the current state and provide a foundation for developing a roadmap and plan for the development of the RI functionality in DHA.
  • Analyze and reconcile suspended charges and Discharged Not Final Billed (DNFB). Based on the analysis, use a sprint framework to identify and prioritize proposed projects and reduce the backlog.
  • Support a roadmap to pilot and then roll out a scalable enterprise Revenue Cycle program.
  • Help design and implement a portfolio of Revenue Cycle decision-support tools focused on the most important Key Performance Indicators for fiscal health.
  • Support and leverage business process re-engineering efforts to achieve standardization within all Revenue Cycle areas.
  • Apply principles and practices in Revenue Cycle management, such as charge capture, coding, billing, reimbursement, denial management, and compliance.
  • Training support/collaboration on end user training materials and workflow collateral

Basic Requirements:

  • Requires a Bachelor's degree in a clinical or healthcare-related field. An Associate degree combined with an additional five (5) years of Revenue Cycle experience may be substituted for the Bachelor's degree.
  • Can achieve a Favorable Suitability Adjudication, based on a T1 background investigation.
  • Due to the nature of the government contract requirements and/or clearance requirements, US citizenship is required.
  • Substantial knowledge and a working understanding of Revenue Cycle concepts, business processes, and/or operations within the healthcare industry.
  • Ability to analyze and interpret complex data, processes, and reports related to revenue cycle and integrity and identify and resolve related issues and problems
  • Ability to collaborate and communicate effectively with team members, clients, business partners, and other various stakeholders involved in revenue cycle.
  • Ability to succeed in a dynamic team environment and produce deliverables in tight timeframes.
  • Microsoft Office 365 proficiency (Excel, Word, PowerPoint).
  • Excellent oral, written, and interpersonal skills.

Desired Qualifications:

  • Must have a Favorable Suitability Adjudication, based on a current T1 background investigation.
  • Possess a DHA issued Common Access Card (CAC)
  • Substantial experience within the Military Health System (MHS) environment and requisite knowledge of revenue cycle operations.
  • Ability to use various software applications and tools to perform Revenue Cycle functions, such as Electronic Health Record systems (Oracle/Cerner Patient Accounting Module (CPAM)), billing/claim solutions/systems (Electronic Claims Clearinghouse (SSI), 3M 360 Encompass Institutional & Professional Coding, Claim Scrubber Edits (Alpha ii), Dentrix Billing, Patient Statements/Letters (RevSpring)), and data analytics tools/repositories (Excel, Power BI, SAS, Tableau, HealtheAnalytics).
  • Knowledge of MHS billing and coding policies and regulations.
  • Experience with the Oracle/Cerner Electronic Health Record (EHR) (MHS GENESIS), Patient Accounting Module (CPAM) and reports: HealtheAnalytics, Discern Reporting Portal, and Lights On Network, ideally in the MHS environment.
  • Experience in the following MHS GENESIS roles: CPA: Accounting/Biller/Poster, CPA: Management, CS: Charge Analyst Local, and Scheduling Basic.

Diversity, Equity & Inclusion Statement:

The Seneca Holdings family of companies is committed to building an inclusive work environment that encourages, supports, and celebrates the diversity of our employees. We recognize that an inclusive corporate culture improves how we support our customers and also improves the collective impact we can make in our communities.

Equal Opportunity Statement:

Seneca Holdings provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex/gender, sexual orientation, national origin, age, disability, marital status, genetic information and/or predisposing genetic characteristics, victim of domestic violence status, veteran status, or other protected class status. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and training. The Company also prohibits retaliation against any employee who exercises his or her rights under applicable anti-discrimination laws. Notwithstanding the foregoing, the Company does give hiring preference to Seneca or Native individuals. Veterans with expertise in these areas are highly encouraged to apply.

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