Healthcare Revenue Cycle Specialist

1 week ago

Tustin, California, United States SG HOMECARE INC Full time
Job Overview

The Healthcare Revenue Cycle Specialist will collaborate closely with both internal and external teams, including insurance providers, serving as a subject matter expert (SME) to pinpoint and rectify systemic payment challenges within the Revenue Cycle Management (RCM) department. This role encompasses RCM process evaluation and enhancements, involvement in training and mentorship, as well as the creation and assessment of training and operational documentation. Additionally, it may involve contributing to the development and support of process automation initiatives.

Key Responsibilities

In executing the responsibilities outlined, the specialist will:

  • Extract, manipulate, analyze, and summarize utilization and internal data across various reporting platforms to generate comprehensive reports and analytics for key stakeholders.
  • Oversee all facets of client billing, including bill preparation, daily process management, research and analysis, troubleshooting, problem resolution, reporting, and special projects.
  • Create budget forecasts for clients, assist in collections, interpret and communicate client billing guidelines, and coordinate special billing arrangements.
  • Manage the accounts receivable process, including billing, invoicing, and collections.
  • Review and analyze accounts receivable aging reports to identify overdue accounts and take appropriate actions.
  • Investigate and resolve billing discrepancies or disputes promptly.
  • Monitor and reconcile customer accounts to ensure accuracy and completeness.
  • Analyze revenue cycle metrics and key performance indicators (KPIs) to identify trends and areas for enhancement.
  • Develop and implement strategies to optimize accounts receivable processes and enhance collection efficiency.
  • Generate reports and presentations to communicate findings and recommendations to management.
  • Maintain positive relationships with customers, addressing inquiries and concerns related to billing and payments in a professional and timely manner.
  • Collaborate with internal teams, including sales, customer service, and finance, to resolve customer issues and improve revenue cycle performance.
  • Ensure compliance with relevant laws, regulations, and company policies related to billing and collections.
  • Maintain accurate documentation of billing and collection activities, including invoices, payment records, and correspondence with customers.
  • Identify opportunities for process improvement and automation to streamline accounts receivable processes and reduce inefficiencies.
  • Work cross-functionally with other departments to implement process enhancements and best practices.
  • Submit and manage rejections of electronic invoices.
  • Assist customers with billing inquiries, troubleshoot issues, and follow up with necessary departments.
  • Monitor validation and payment approvals, research and resolve invoice rejection issues, initiate corrective measures, and communicate with billing vendors regarding outstanding balances.
  • Extract, analyze, and summarize claim data from the practice management system to identify contract compliance issues and underpayments.
  • Maintain expertise regarding specific payers, clinic operations, and RCM functional components.
  • Maintain ongoing project timelines and status with regular updates to the team.
  • Manage resources related to owned projects and issues.
  • Ensure data integrity and accuracy of all analysis and summary reports completed.
  • Implement system changes and updates as required to support departmental operations.
  • Identify project issues and risks and help formulate mitigation strategies.
  • Support management in achieving project goals.
  • Conduct audits and prepare audit reports for functional areas of responsibility, reporting any concerns to management.
  • Monitor productivity for all projects and functional areas of responsibility, reporting any concerns to management.
  • Serve as a valuable subject matter expert and support resource for the RCM team.
  • Perform daily departmental duties as assigned.
  • Complete special projects as assigned.
  • Train new RCM Accounts Receivable Analysts.
Qualifications

To be considered for this role, candidates should possess:

  • A minimum of four years of billing experience in a healthcare setting, with five years or more preferred.
  • Proven experience in accounts receivable management or revenue cycle analysis.
  • Strong analytical skills with the ability to interpret financial data and identify trends.
  • Proficiency in Microsoft Excel and other accounting software.
  • Excellent communication and interpersonal skills.
  • Detail-oriented with a high level of accuracy and integrity.
  • Ability to prioritize tasks and work efficiently in a fast-paced environment.
  • Knowledge of relevant laws and regulations governing billing and collections is preferred.
  • An associate's or bachelor's degree is preferred; commensurate experience may be considered in lieu of education.
  • Strong analytical and critical thinking skills.
  • A collaborative mindset with strong interpersonal skills.
  • Superior customer service skills and the ability to work in a challenging and dynamic environment.
  • Self-directed with a strong work ethic; capable of working independently with limited supervision.
  • Ability to multitask and meet stringent deadlines in a fast-paced work environment.
  • Excellent organizational and time-management skills.
  • Demonstrated proficiency with Microsoft Office products, particularly MS Excel, including advanced features such as pivot tables, graphs, formulas, and macros.
  • Experience working with client Document Management Systems (DMS).
  • Ability to create spreadsheets, manipulate data, and generate reports.
  • Excellent verbal and written communication skills with the ability to effectively present results to senior management.
  • Ability to perform well in a cross-functional environment and interface effectively with senior management, vendors, and client staff.
  • Ability to handle sensitive matters with confidentiality.

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