Revenue Cycle Specialist I

Revenue Cycle Specialist

The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues. This is a remote position.

Essential Functions & Responsibilities:

• Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines
• Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims
• Identify errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners
• Perform contract and reimbursement variance analysis
• Analyze claims data to identify contractual overpayments and billing errors
• Assist department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources
• Learn or remain current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing
• Provide subject matter expertise on billing and coding guidelines and regulations as required by the department
• Use internal and external billing protocols and regulations for repricing bills at a cost savings to the customer
• Identify trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing
• Establish and maintain detailed knowledge and documentation of all analysis/data sources within the department
• Analyze all forms of Revenue Cycle transactions
• Run standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders
• Produce daily, monthly and annual evaluations and statistical reports, analyzing drivers of variances over time to ensure the integrity and accuracy of revenue cycle data
• Evaluate integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances
• Ensure strict confidentiality of all medical records, PHI, and PII
• Additional duties as assigned

Knowledge & Skills:

• Demonstrated knowledge of claims processing, DRG Validation, CMS guidelines, and ICD-10 coding guidelines as applicable
• Detailed knowledge of pay reimbursement methodology
• Strong understanding of healthcare revenue cycle and claims reimbursement
• Knowledge of Microsoft Office products, including Word, PowerPoint, Excel and Outlook, Windows operating system and Internet
• Ability to work independently and use critical thinking
• Strong analytical and problem-solving skills
• Strong attention to detail and ability to deliver results in a fast paced and dynamic environment

Education & Experience:

• Claims repricing, pricing configuration, or provider maintenance experience required
• 3+ years of relevant experience or equivalent combination of educations and work experience
• High School Diploma or equivalent required

Pay Range: $19.21 - $28.73 per hour

About CERIS:

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.