Senior Revenue Cycle Specialist

Position Summary At Stony Brook Medicine, the Senior Revenue Cycle Specialist will act as an operational leader in the Hospital's Business Office to analyze, track, and pursue the payment of under‑paid and denied accounts receivable. Successful candidates will have a bachelor's degree and three years of healthcare revenue cycle experience or, in lieu of a degree, five or more years of experience in an Acute Care Hospital Revenue Cycle or Patient Accounting Department resolving hospital Managed Care payment variances and/or denials. Job Responsibilities Develop staff work listing logic/strategy and claims resolution workflows. Educate and train new staff regarding departmental/unit policy and procedure, including Managed Care Contracts. Monitor work queues and staff productivity to ensure work volumes and staffing are aligned. Audit staff work and provide education on best practice. Supervise junior staff. Complete employee performance programs and evaluations, scheduling and timesheets. Analyze and identify claim payment issues, patterns, and root cause; track and pursue untimely, under‑paid and denied accounts. Collaborate on denials prevention initiatives. Liaise with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials. Collaborate with the Managed Care Department, HIM and Patient Accounting leadership to address payment issues and resolve at‑risk/high‑dollar accounts. Analyze new contracts and work with Contract Management system support to troubleshoot contract rates and terms. Participate in Joint Operating Calls (JOC) with insurance payers. Monitor medical record request, correspondence distribution and scanning processes, volume, and trends. Assist in maintaining and creating payer report cards, claims tracking and management reporting as requested. Assist management reporting and special projects as requested. Qualifications Required Bachelor’s degree and three years’ healthcare revenue cycle experience, or in lieu of a degree, five years of healthcare revenue cycle experience resolving hospital Managed Care payment variances and denials. Expert knowledge of Medicare and NY Medicaid inpatient and outpatient reimbursement methodologies. Expert knowledge of third‑party reimbursement methodology and associated healthcare claim drivers. Expert knowledge of inpatient and outpatient billing requirements (UB‑04, 837i). Experience working with CPT/HCPCS and ICD‑10 codes. Experience working with Cerner InVision Patient Accounting. Proficiency in MS Office Suite, including Excel and Word. Excellent written and verbal communication skills. Preferred Experience working within Cerner Contract Management, Epic or equivalent including experience validating the configuration and build of contracts. Medical coding certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA). Proficiency with MS Access, Visio and/or PowerPoint. Knowledge of SQL or database queries. Experience reporting from healthcare decision support, patient accounting, contract management and/or claims scrubber systems. Proficiency with SAP Business Objects / Crystal Reports. Proficiency with visualization software (Tableau, MS Power BI, etc.). Salary and Benefits Anticipated Pay Range: $80,408 – $94,211 per year. The salary will be based on the candidate’s validated years of comparable experience. In addition to base salary, eligible employees may receive location pay ($4,000) and participate in the university’s health plans, leave benefits and state pension. Location and Schedule Primary Location: US‑NY‑East Setauket. Schedule: Full‑time, Day Shift (8:30am‑5:00pm). Pass Days: Saturday, Sunday. Application Verification of degree is required. Please upload official documentation with your application. Equal Opportunity Employer Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws. #J-18808-Ljbffr