Senior Revenue Cycle Specialist

Job Description

Job Description

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It's no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Senior Revenue Cycle Specialist will play a pivotal role in managing and overseeing key aspects of our claims processing activities, including claim submissions, denials management, and insurance verification. As a critical member of our growing practice, you will ensure that our revenue cycle operates efficiently and accurately by submitting claims, triaging denials, and collaborating with clinical staff to resolve documentation issues. You will also be responsible for generating reports for senior management and overseeing patient registration, scheduling, and cost-sharing collection processes. This role requires exceptional attention to detail, the ability to collaborate across departments, and a proactive approach to identifying and resolving issues related to claims processing. The ideal candidate will bring strong experience with medical billing, proficiency in athenahealth EHR, and a solid understanding of alternative payment models and non-traditional claims submissions.

Skills Required:

• Strong knowledge and experience with medical billing and claims processing, including insurance verification, patient registration, and cost-sharing collection.
• Experience with athenahealth EHR.
• Experience with Salesforce preferred.
• High attention to detail and strong organizational skills.
• Proficient in using data and reports to inform work and optimize revenue cycle performance.
• Excellent written and verbal communication skills.
• Ability to work independently while also collaborating with multiple departments.
• Strong multitasking abilities in a dynamic, fast-paced environment.
• Ability to manage time effectively and prioritize multiple tasks.
• Experience with alternative payment models and non-traditional claims submission.

Key Behaviors:

Claims Processing Management:

• Submit accurate claims, handle denials and rejections, and ensure all claims have complete and accurate diagnosis and procedure codes.

Cross-functional Collaboration:

• Work closely with clinical teams to resolve missing or inconsistent documentation and collaborate with technology teams on claims generated via algorithmic processes.

Reporting & Transparency:

• Generate and share regular claims status reports with senior management, providing visibility into revenue, accounts receivable, and cash collections.

Patient Interaction:

• Ensure accurate patient registration, verify insurance eligibility, and collect necessary cost-sharing amounts.

Problem-Solving & Initiative:

• Identify trends in denials and proactively address issues to improve overall claims processing efficiency.

Adaptability & Resilience:

• Thrive in a growing practice and adjust to evolving responsibilities, contributing to a flexible and dynamic work environment.

Competencies:

Attention to Detail:

• Ensures that claims submissions are accurate and thorough, minimizing errors and rejections.

Communication Skills:

• Ability to convey complex information clearly to patients, clinicians, and other team members.

Analytical Skills:

• Strong ability to analyze data, identify trends, and propose improvements to the revenue cycle process.

Time Management:

• Effectively balances multiple responsibilities in a fast-paced environment, ensuring deadlines are met and tasks are completed efficiently.

Customer Service Orientation:

• Provides excellent service to internal teams and patients while maintaining professionalism.

Process Improvement:

• Continuously looks for ways to streamline and enhance revenue cycle operations.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

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