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Revenue Cycle Specialist

2 months ago


Chardon, Ohio, United States University Hospitals Full time
Job Summary

As a key member of the Revenue Cycle team at University Hospitals, the Revenue Cycle Precert Specialist plays a vital role in ensuring that authorizations for outpatient testing, ambulatory, and inpatient services are obtained before services are rendered. This position requires strong communication and relationship-building skills, as well as the ability to function independently and as a team player in a fast-paced environment.

Key Responsibilities
  • Verify and pre-certify inpatient and outpatient services to ensure appropriate reimbursement from third-party payers, government payers, and state agencies.
  • Mastery of skills relating to insurance coverage, benefits, rules, and regulations, as well as allocation of plans and fulfillment of requirements resulting in expected payment for services.
  • Verify and allocate insurance plans utilizing electronic eligibility tools, phone calls to payers, and access to web portals, initiating appropriate action for services, including non-covered and out-of-network insurance services.
  • Submit timely electronic and verbal notifications and clinical documentation in accordance with contractual requirements and payer guidelines, coordinating with operations and clinical counterparts to obtain and submit necessary information and documentation.
  • Communicate potential issues and follow GM-98, Service with Authorization guidelines to notify providers of pending authorizations/denials and peer-to-peer requests, escalating encounters per policy.
  • Effectively communicate with internal and external customers using telephone, email, or correspondence, understanding when and how to escalate cases that require operations and leadership attention to initiate appropriate action.
  • Maintain up-to-date knowledge of computer applications, insurance/government regulations, managed care guidelines, and Revenue Cycle policies/procedures used within the department.
  • Scan and retrieve appropriate related documents in scanning applications.
  • Attend and participate in corporate and local team meetings, maintaining patient/physician confidentiality.
  • Ensure compliance with department productivity and quality standards.
Additional Responsibilities
  • Perform other duties as assigned.
  • Comply with all policies and standards.
  • For specific duties and responsibilities, refer to documentation provided by the department during orientation.
  • Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct, and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
Requirements
  • High School Equivalent/GED (Required)
  • 1+ years of experience in hospital Revenue Cycle/healthcare, working with insurance companies/third-party payers or related experience (Required)
  • Experience with clinical applications (Preferred)
Knowledge, Skills, & Abilities
  • Knowledge of managed care insurance requirements is essential (Required proficiency)
  • Notable client service, communication, and relationship-building skills (Required proficiency)
  • Ability to function independently and as a team player in a fast-paced environment (Required proficiency)
  • Must have strong written and verbal communication skills (Required proficiency)
  • Professional demeanor (Required proficiency)
  • Detail-oriented and organized, with good analytical and problem-solving ability (Required proficiency)
  • Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e., printers, copy machine, multi-line phone, FAX machine, etc.) (Required proficiency)
Physical Demands
  • Standing Occasionally
  • Walking Occasionally
  • Sitting Constantly
  • Lifting Rarely 20 lbs
  • Carrying Rarely 20 lbs
  • Pushing Rarely 20 lbs
  • Pulling Rarely 20 lbs
  • Climbing Rarely 20 lbs
  • Balancing Rarely
  • Stooping Rarely
  • Kneeling Rarely
  • Crouching Rarely
  • Crawling Rarely
  • Reaching Rarely
  • Handling Occasionally
  • Grasping Occasionally
  • Feeling Rarely
  • Talking Constantly
  • Hearing Constantly
  • Repetitive Motions Frequently
  • Eye/Hand/Foot Coordination Frequently
Travel Requirements
  • 10%