Revenue Cycle Specialist

3 weeks ago

Martinsville, Virginia, United States Sovah Health - Martinsville Full time
Job Summary

We are seeking a highly skilled Revenue Cycle Specialist to join our team at Sovah Health - Martinsville. The successful candidate will be responsible for coordinating, evaluating, and measuring revenue integrity operations, developing systems to manage medical necessity denials, and tracking mechanisms to measure loss leaders and improvements by service line, payer, and provider.

Key Responsibilities
  • Document and track all RAC and Payer audit requests, including maintaining the RAC and Arthur Databases to ensure that all timelines are met.
  • Manage the submission of records and respond to denials and appeals requests.
  • Share RAC findings with key members of the organization.
  • Coordinate and manage numerous RAC notifications in varying phases of appeal based on feedback.
  • Log, notify, and scan all Government correspondence coming into the facility, ensuring that all appropriate parties are informed. Maintain e-requests.
  • Work with departments that impact the hospital's ability to develop and document processes that facilitate clean automated billing of hospital claims.
  • Work directly with clinical operating departments, Managed Care & Reimbursement, Supply Chain, and business office personnel to ensure the hospital receives all reimbursement to which it is entitled through appropriate charging and coding of patient claims.
  • Assist with SOX audits, insurance denial appeals, and patient charge concerns/complaints as needed.
  • Participate in the development of policies and procedures and ensure compliance within the Revenue Cycle.
  • Participate and collaborate in the resolution of Revenue Cycle issues and refinement of the process to prevent future issues.
  • Verify insurance benefits and obtain precertification/authorization as necessary. Determine and accept required payments, including co-pays and deductibles, or refer to financial counselors for follow-up.
  • Perform medical necessity checks, when appropriate.
  • Provide coverage to other areas of registration when necessary.
Requirements
  • High school diploma or equivalent required. College education or 2 years' experience preferred.
  • Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.
  • Must be able to work in a stressful environment and take appropriate action.
  • Knowledgeable and experienced with hospital bill processing and insurance practices.
  • HCPC/CPT/UB04 experience, modifiers, Medicare APC's, and billing regulations required.
  • Experience in reimbursement analysis, good written and verbal communication skills, demonstrated knowledge of Medical Terminology, strong organizational skills, and the ability to multi-task.
  • Strong computer skills, including Excel, and the ability to interact positively with internal and external customers.
  • Skills in researching and resolving problems, issues, and the ability to articulate audit findings.
  • Able to perform work duties with minimal supervision.

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