Revenue Cycle Specialist

Description:

Job Classification:

• This is an exempt position under the Fair Labor Standards Act (FLSA) and is not eligible for overtime pay.

Our Mission:

Our mission is to drive financial wellness in healthcare organizations so more patients can receive the care they need.

Our Vision:

Our vision is a future where we help healthcare organizations thrive in a complex ecosystem by clearing a path to financial health.

Our Culture:

We are committed to creating a workplace where every member feels valued, empowered, and inspired to contribute their best. Together we will foster a culture that promotes work-life balance and celebrates community engagement, personal achievements, milestones, and special occasions.

Values:

Integrity – We do what’s right, no matter what.

Innovation – We use a harmonious blend of data, tech, and a human-centric approach.

Compassion – We understand the stress of healthcare organizations and their patients.

Determination – Our mission is our guiding force.

Partnership – We build enduring relationships through listening, communication and accountability.

Dignity – We have significant pride in each other and our work.

Job Summary:

The Revenue Specialist will demonstrate behavior that supports PC3’s mission, culture, and values. The successful candidate will play a crucial role in optimizing the financial health of the client by identifying and successfully resolving, recovering, and preventing potential loss of revenue due to claim payment issues. They must have experience in a healthcare environment and with the insurance and revenue cycle industry and be well versed in CPT medical codes and denial reason codes.

The Revenue Specialist will take necessary follow-up actions, including appealing denied claims with appropriate documentation and justification, identify and correct billing issues related to denials and claim rejections, dispute underpayments, audits, recoupments, report trends, and actively participate in process improvement projects when necessary. The specialist’s persistence helps recover revenue that might otherwise be lost due to claim denials. For this reason, the Revenue Specialist must stay informed about healthcare regulations, privacy laws, and insurance policies and ensure billing practices align with legal requirements and must adhere to compliance standards and regulations related to medical billing and coding.

This position reports directly to the Director of Revenue Strategy.

Supervisory Responsibilities:

This position has no direct supervisory responsibilities.

Duties/Responsibilities:

• Manage denials, appeals, audits, and other revenue cycle functions.
• Review accounts pre-service for adherence to payor guidelines including but not limited to validating correct coding, reviewing payor policies, and obtaining prior authorization.
• Coordinating with insurance providers and resolving claim denials or discrepancies.
• Effectively communicating with patients and insurance companies is essential for successful collections.
• Work product and performance are required to meet quality standards established by PC3 partners.
• Analyze data and trends to identify opportunities for process improvement.
• Participate in process reviews and implementation for clients.
• Maintain confidentiality of patient information in accordance with HIPAA guidelines.
• Attend educational sessions including but not limited to webinars, online resources, in-person conferences, and other educational opportunities to stay up to date on revenue cycle functions as necessary.
• Other duties as assigned.

Requirements:

Knowledge/Skills/Abilities:

• Knowledge of healthcare regulations, accreditation standards, and payer requirements.
• Strong computer skills and working knowledge of the Electronic Medical Records (EMRs).
• Requires communication skills to communicate clearly and concisely verbally and in writing with clients, peers, payers, physicians, and ancillary departments.
• Knowledge/experience utilizing the Epic software system and/or other billing platforms.
• Proficient in Microsoft Office applications.
• Strong interpersonal and organizational skills.

Education and Experience:

• High school diploma
• LPN or RT preferred
• 3 Years Revenue Cycle experience.
• Familiarity with the insurance industry.
• Applied knowledge of CPT, ICD & DRG coding systems.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.