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Revenue Cycle Management Technician
2 months ago
Position Summary
Sovah Health is seeking a dedicated professional to oversee and enhance revenue cycle integrity operations. This role involves developing strategies to manage medical necessity denials and implementing tracking systems to assess losses and improvements across various service lines, payers, and providers.
Key Responsibilities:
- Maintain comprehensive documentation and tracking of all RAC and payer audit requests, ensuring compliance with timelines through the management of the RAC and Arthur Databases.
- Oversee the submission of medical records and respond effectively to denial and appeal requests.
- Communicate RAC findings with essential stakeholders within the organization.
- Coordinate and manage multiple RAC notifications at different stages of appeal based on received feedback.
- Log and notify relevant parties of all government correspondence received by the facility, ensuring all necessary parties are informed and maintaining e-requests.
- Collaborate with various departments to develop and document processes that support accurate automated billing of hospital claims, identifying and addressing issues related to personnel, processes, and technology.
- Provide necessary education and competency assessments to staff impacting the revenue cycle, preparing educational materials as required.
- Work closely with clinical departments, Managed Care & Reimbursement, Supply Chain, and business office personnel to ensure appropriate charging and coding of patient claims for maximum reimbursement.
- Assist with SOX audits, insurance denial appeals, and address patient charge inquiries and complaints as needed.
- Contribute to the development of policies and procedures, ensuring compliance within the revenue cycle.
- Engage in resolving revenue cycle issues and refining processes to prevent future occurrences.
- Stay updated on current trends and regulatory changes within the healthcare revenue cycle.
- Verify insurance benefits and obtain necessary precertifications/authorizations, managing required payments including co-pays and deductibles, or referring to financial counselors as needed.
- Conduct medical necessity checks when appropriate.
- Provide coverage to other registration areas when necessary.
About Us:
People are our passion and purpose. Join a team that values you for who you are and what you bring to the table. SOVAH Health – Martinsville is a fully licensed acute-care hospital offering a wide range of medical specialties, including home health and hospice services, advanced wound healing, cardiac rehabilitation, and oncology services.
Why Choose Us:
- Comprehensive health benefits (Medical, Dental, Vision) and 401K for full-time employees.
- Competitive Paid Time Off and Extended Illness Bank for full-time employees.
- Employee Assistance Program focusing on mental, physical, and financial wellness.
- Tuition reimbursement for eligible candidates.
- Opportunities for professional development and mentorship.
- And much more...
Minimum Qualifications:
Education: High school diploma or equivalent required; college education or two years of relevant experience preferred.
Skills: Strong critical thinking and judgment skills with the ability to work independently in a fast-paced environment. Proficient in hospital billing processes and insurance practices, including HCPC/CPT/UB04 coding, Medicare APCs, and billing regulations. Excellent written and verbal communication skills, along with strong organizational abilities and multitasking capabilities. Proficient in computer applications, including Excel, and capable of positive interactions with internal and external customers. Demonstrated problem-solving skills and ability to articulate audit findings. Self-motivated and eager to learn new tasks.
Experience: Preferred two years of experience in hospital revenue cycle management, with a focus on patient accounting and billing systems. Familiarity with coding (CPT, diagnosis, revenue, and insurance codes) and knowledge of billing regulations, including Medicare and Medicaid guidelines, is essential.
EEOC Statement: SOVAH Health - Martinsville is committed to providing equal employment opportunities for all applicants and employees, complying with all applicable laws prohibiting discrimination based on color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status, or any other protected status.
We are an equal opportunity and affirmative action employer, seeking diversity in our candidates.
