Medical Revenue Operations Professional

3 weeks ago


Brooklyn, New York, United States The Brookdale Hospital Medical Center Full time

Job Summary:

The Brookdale Hospital Medical Center is seeking a skilled Medical Revenue Operations Professional to join our team. As a key member of our revenue cycle operations department, this individual will be responsible for maximizing reimbursement levels for professional services by analyzing denial and rejection reports and appeals, working directly with practices, payors, and patients to resolve claims, and addressing core issues driving denials or slow payments with appropriate staff.

Responsibilities:

  • Denial and Reconciliation: Review and clear hold buckets for professional fee claims, and effectively manage Medicaid pending and workers compensation claims support.
  • Payor and Practice Relationships: Develop expert knowledge of the AthenaHealth practice management system, and establish strong relationships with key payor representatives for timely claim adjudication.
  • Coding and Documentation: Maintain a working knowledge of CPT-4 and ICD-9/10-CM coding principles, governmental regulations, protocols, and third-party requirements pertaining to billing and documentation.
  • Communication and Support: Provide accurate and concise communication to practices, inform them of best practices, and ensure maximum efficiency and reimbursement for properly documented services.
  • Policy and Procedure Development: Review, modify, and recommend changes to policies and procedures to improve professional fee billing and maximize reimbursement.
  • Financial Management: Effectively manage A/R, bad debt, credit balance/refunds, and collections, and reconcile all payments, produce financial month-end reports, track, scan, and upload payments to Athena.
  • Insurance and Facilities: Obtain Insurance Web access for all facilities, and set up ERA/EFT.

Requirements:

  • Education: Associates Degree or Successful completion of an AHIMA-approved Coding Certificate Program.
  • Experience: Prior experience using AthenaHealth practice management or similar physician practice management system, and a minimum of three years of professional fee reimbursement experience.
  • Skills and Knowledge: Thorough working knowledge of ICD-9/10-CM and CPT-4 coding systems, medical terminology, physician reimbursement models, and medical abbreviations, with the ability to fully utilize BHMC's electronic record systems, equipment, and other healthcare and billing systems.

Estimated Salary:

$65,000 - $85,000 per year, depending on experience and qualifications.



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