Revenue Cycle Specialist II

Revenue Cycle Specialist II

The Revenue Cycle Specialist II is responsible for analyzing and optimizing the financial processes within a healthcare organization, including patient registration, billing, coding, claims submission, and collections, by identifying areas for improvement, monitoring key performance indicators (KPIs), and implementing strategies to maximize revenue while adhering to compliance regulations; essentially acting as a data-driven expert to streamline the revenue cycle and ensure accurate and timely payments from insurance companies and patients.

Essential Duties & Responsibilities:

• Work closely with Revenue Cycle Business Analysts and Revenue Cycle Financial Analysts working claims not limited to but including the following:
• Prepare Complex Medical Records Request and review documents for accuracy, completeness, and congruency
• Interpret Payer Correspondence and determine next appropriate action
• Submit carrier appeals and reconsideration requests in a timely manner based on SOPs or make suggestions to enhance SOP's
• Review and update line-item receipt posting (LIRP) as needed or other posting needs.
• Work assigned hold codes and determine next actions including, but not limited to, Bad Addresses, Eligibility, and other denial reasons.
• Maintain accurate tracking of client and referring provider documentation and obtain any missing documentation to ensure accuracy and completeness
• Ensure all relevant claims and appeal documentation is uploaded into OnBase
• Verify all identified insurance carriers for policy related to prior authorization requirements as needed for claims adjudication
• Work collaboratively with other Coding, Billing, Patient Access, and Cash Receipts Specialists as needed
• Mentor and train new team members
• Lead small-scale projects focused on process optimization

Successful Candidates Must Possess:

• High School diploma or GED required; Associate's or Bachelor's Degree in Business, Finance, or related discipline preferred
• With a High School diploma, a minimum of five (5) years of experience performing revenue cycle processes in a hospital, laboratory, ambulatory surgery center, or large medical practice with a minimum of two (2) years in denials management required; With a Bachelor's degree, a minimum of two (2) years of finance/accounting experience required
• Knowledge of ICD9, ICD10, CPT, and HCPCS coding strongly required
• Strong working knowledge of Microsoft Office, including Excel and Outlook
• Ability to take direction and follow Standard Operating Procedures with a high degree of accuracy
• Strong attention to detail and the ability to work in a fast-paced, team-oriented environment with a focus on communication required
• Demonstrated ability to lead initiatives and mentor others

Aegis Sciences Corporation is an Equal Opportunity Employer