Revenue Cycle Specialist

Description

JOB SUMMARY

The Revenue Insights Specialist will collaborate with Payer Escalations and PII Managers in order to provide data driven input that will optimize payer recovery. You will closely examine payer contracts, research payment account adjudication, claims and electronic remittance information to identify trends and changes in payer behavior. Leveraging revenue cycle data, you will manage a portfolio of payers and get assigned projects to improve revenue cycle performance and provide value to our clients.

ESSENTIAL DUTIES AND RESPONSIBILITIESinclude the following. Other duties may be assigned.

• Perform high-level contract overview to ensure accuracy of contract terms and conditions. Solid understanding of healthcare reimbursement methodologies, analyze data findings, and be able to escalate issues as needed.
• In depth knowledge of applicable contracts. Continual QA and analysis of underpayment risk areas to ensure audit accuracy. Ensure compliance with state and federal laws and regulations. Maintains a thorough understanding of health insurance and government programs, where necessary.
• Prepare groups of accounts based on logged information to provide stakeholders with clean actionable issues to drive payer results. Coordinate efforts with stakeholders to drive changes in auto adjudication, aging and cycle
• Monitor payer memos and create communication on changes to support teams
• Write and update existing SQL queries

SUPERVISORY RESPONSIBILITIES

If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

• No. Direct Reports (incl, titles) Patient Acct Reps, Sr Patient Acct Reps, Lead Patient Acct Reps, and Patient Acct Supervisors
• No. Indirect Reports (incl. titles)

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Advanced knowledge of healthcare A/R
• Independent, logical thinker with proven ability to perform detailed data analysis and make sound decisions
• Analytical, logical thinker and attention to detail
• Proficient in Microsoft Office (Word and Excel)
• Intermediate knowledge of managed care and other healthcare contract language
• Intermediate knowledge of healthcare reimbursement and patient accounting principles
• Intermediate understanding of ICD-10, HCPCS/CPT coding, medical terminology, hospital billing form requirements (UB-04), and electronic remittance advice (ERA/835) responses
• Demonstrated ability to detect patterns in large volumes of data
• Query/SQL experience required
• Very good written and verbal communication skills
• Strong interpersonal skills

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Bachelor’s degree preferred in Healthcare Administration, Business or related area or equivalent experience. MBA/CPA preferred
• 2-4 years working in a managed care or healthcare environment with end-to-end revenue cycle experience
• 1-2 years’ experience in analysis of payer trends and proven track record of using data to provide actionable business results
• Proficient in Microsoft Excel, Word, PowerPoint, and SharePoint

CERTIFICATES, LICENSES, REGISTRATIONS

• HFMA-Patient Accounts or Hospital Accounting Certification encouraged

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit and work at a computer terminal for extended periods of time

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $22.56 - $33.85 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.