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Revenue Cycle Specialist

2 months ago

Martinsville, Virginia, United States Sovah Health - Martinsville Full time
About the Role

We are seeking a highly skilled Revenue Cycle Specialist to join our team at Sovah Health - Martinsville. As a key member of our revenue integrity team, you will play a critical role in ensuring the accuracy and compliance of our revenue cycle operations.

Key Responsibilities
  • Coordinate and evaluate revenue integrity operations to ensure compliance with regulatory requirements and industry standards.
  • Develop and implement systems to manage medical necessity denials and track loss leaders by service line, payer, and provider.
  • Document and track RAC and payer audit requests, maintaining databases to ensure timely compliance.
  • Manage the submission of records and respond to denials and appeals requests.
  • Share RAC findings with key stakeholders and coordinate appeals processes.
  • Log, notify, and scan government correspondence, ensuring all parties are informed.
  • Collaborate with departments to develop and document processes for clean automated billing of hospital claims.
  • Participate in project teams and lead initiatives to improve revenue cycle processes and compliance.
  • Work with clinical operating departments, managed care, and business office personnel to ensure accurate reimbursement.
  • Assist with SOX audits, insurance denial appeals, and patient charge concerns.
  • Participate in the development of policies and procedures to ensure revenue cycle compliance.
Requirements
  • High school diploma or equivalent required; college education or 2 years' experience preferred.
  • Critical thinking skills, decisive judgment, and ability to work with minimal supervision.
  • Knowledge of hospital bill processing, insurance practices, and HCPC/CPT/UB04 experience.
  • Strong organizational skills, ability to multi-task, and excellent communication skills.
  • Ability to work in a stressful environment and take appropriate action.
Preferred Qualifications
  • Two years' hospital revenue cycle experience preferred.
  • Physician billing/reimbursement experience helpful.
  • Demonstrated expertise in patient accounting management and billing systems.
  • Experience with coding and billing regulations, including Medicare IP PPS and OPPS.
About Sovah Health - Martinsville

We are a 220-bed, full-service acute-care hospital providing over 22 medical specialties. Our mission is to provide exceptional patient care and service to our community. We offer a range of benefits, including health insurance, 401K, and tuition reimbursement. We are an equal opportunity employer and welcome diversity in our candidates.