Healthcare Revenue Cycle Coordination Specialist

2 weeks ago

Rapid City, South Dakota, United States Monument Health Full time

Current Employees:

If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.

Primary Location
Rapid City, SD USA

Department
RCH Revenue Cycle Management Services

Scheduled Weekly Hours
40

Starting Pay Rate Range
$29.94
(Determined by the knowledge, skills, and experience of the applicant.)

Job Overview
Under the general supervision of the VP of Revenue Cycle, the Healthcare Revenue Cycle Coordination Specialist performs advanced functions to ensure optimal reimbursement for high-cost and high-risk healthcare service requests. Leveraging their expertise, the Coordinator reviews payer medical policies, evaluates medical necessity criteria, and applies critical thinking to determine if the criteria are satisfied to facilitate the scheduling of financially cleared services. This role provides elevated referral management and processing to ensure accurate interpretation, documentation, adjudication, approval, and payment of healthcare service requests. The Coordinator must effectively guide and support all staff, providers, and patients on available options while addressing barriers to obtaining prior authorizations, completing financial clearance, or timely scheduling of services, ensuring resolution and closure to referrals or case requests. This position is vital for securing reimbursements, minimizing organizational financial risk, and optimizing schedule utilization to ensure timely patient access to care.
The Healthcare Revenue Cycle Coordination Specialist must consistently demonstrate proficient communication and problem-solving skills, along with exceptional customer service abilities. They should be capable of de-escalating concerns and anxiety at both patient and provider levels and possess the ability to anticipate and respond to a variety of issues to execute tasks efficiently and effectively. The role requires independent planning, scheduling, and organization of numerous tasks, with the ability to work under pressure and tight deadlines to avoid negatively impacting patient care.

Benefits:
Monument Health offers competitive wages and benefits for qualifying positions, including:

  • Supportive work culture
  • Medical, Vision, and Dental Coverage
  • Retirement Plans, Health Savings Account, and Flexible Spending Account
  • Instant pay options for qualifying positions
  • Paid Time Off Accrual Bank
  • Opportunities for growth and advancement
  • Tuition assistance/reimbursement
  • Excellent pay differentials for evening, night, or weekend shifts
  • Flexible scheduling
Key Responsibilities:
  • Coordinate the scheduling and authorization of referral requests to enhance timely patient access to care while upholding organizational values.
  • Conduct advanced analysis to ensure optimal reimbursement, focusing on mitigating risks associated with high-cost services and surgical care.
  • Adhere to complex scheduling guidelines, accurately interpret orders and treatment plans, and coordinate appointments requiring multiple resources.
  • Independently manage appointment schedule requests, assign resources, and ensure accuracy by collaborating with relevant personnel.
  • Interact effectively with medical and professional staff to secure necessary clinical information for prior authorizations.
  • Review and evaluate referrals for service and appointment to ensure appropriateness and medical necessity based on payer policies.
  • Prioritize urgency of authorizations, considering complexity of procedures and scheduled service dates.
  • Support peer-to-peer and appeal processes from a clinical perspective when payment is denied by the payer.
  • Utilize approved communication pathways to securely gather and share patient information.
  • Understand patient status delineations per payer regulations and engage in interdepartmental discussions.
  • Conduct financial clearance reviews and educate patients/providers on payer complexities.
  • Communicate financial responsibilities to patients regarding service authorization and assist with financial clearance paperwork.
  • Adhere to quality assurance, operational standards, and productivity expectations.
  • Navigate multiple systems independently and maintain confidentiality in handling patient information.
  • Demonstrate proficiency and awareness of best practices in the healthcare industry.
  • Perform other duties as assigned.
Qualifications:
Required:
Education - High School Diploma/GED Equivalent
Experience - 5+ years in healthcare revenue cycle, financial services, or related support services role.
Preferred:
Education - Bachelor's degree in Healthcare Administration, Business, or a medical-related field
Experience - 7+ years in healthcare revenue cycle, financial services, or related support services role.
Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

Job Category
Job Family
Revenue Cycle

Shift

Employee Type
Regular

Make a difference. Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

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