Revenue Cycle Specialist

Billing And Revenue Cycle Expert

Serves as subject matter expert in all billing and revenue cycle activities at TJRH.

Minimum Education

High School Diploma or equivalent is required.

Minimum Work Experience

10 years of revenue cycle coding/billing/collections management

In-Depth knowledge of Medicare/Medicaid reporting, billing regulations and compliance

Working knowledge of federal, state, local, intermediary and private payor specific billing requirements

Working knowledge of all appropriate billing forms, UB04, 1500 or state specified forms, utilizing the electronic billing systems

General knowledge of HIM coding, ICD9 & 10

Complete understanding of CPT's and HCPC including modifiers

Complete understanding of SSI edits and billing related reports

Required Skills

Has advanced knowledge of Microsoft applications including Word, Excel, Outlook and PowerPoint

Has an advanced understanding of coding, billing and compliance practices

Has expert knowledge of large revenue recognition systems and practice billing systems

Possesses expert investigational skills, shows attention to detail, accuracy and ability to manage and prioritize multiple tasks

Ability to work independently

Possesses initiative, analytical skills, and an ability to operate with a high level of productivity

Demonstrates advanced communication and presentation skills

Ability to work and lead in a team environment and develop constructive working relationships with others

Able to lead others through difficult situations.

Functional Demands

Physical Requirements

Sitting 16 31%

Walking - 16 31%

Standing - 16 31%

Bending/Squatting - 1-15%

Climbing/Kneeling - 1-15%

Twisting - 1-15%

OSHA Category

Minimal Potential for Direct Body Fluid Exposure

Visual and Hearing Requirements

Must be able to see with corrective eyewear.

Must be able to hear clearly with assistance.

Other Physical/Environmental Demands

Lifting - 0-50lbs, 50lbs or more with assistance

Carrying - 0-50lbs, 50lbs or more with assistance

Pulling - up to 100lbs

Pushing - up to 100lbs

Leadership Capabilities

Supports the hospital Mission, Service and Values.

Essential Functions

Identifying any revenue cycle reimbursement opportunities for improvement within the hospital operations as well as the provider based and RHC clinics

Training and educating hospital departments on charge capturing, reconciliation and correction with specific follow up techniques and billing requirements.

Informing hospital departments on new regulations from insurance carriers to ensure compliance with proper billing guidelines necessary for reimbursement

Working the unbilled report with necessary departments to reduce unbilled days

Identifying and resolving any charging issues (improper charges and/or missing charges) as well as charging issues outside workflow process. Escalating the issues to management when necessary

Ensuring appropriate prior treatment authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and follows up in a timely manner

Researching for proper charging for billing requirement to ensure submission of clean and compliant claims to governmental and private payers

Identifying and resolving core issues causing delayed payments, under payments, claim denials and zero pays

Periodically auditing bills and comparing to medical records and clinical documentations to support claims or appeals as necessary

Working on financial or compliance audits as necessary

Working with Business Office Leadership to improve the AR, Cash Flow and other key indicators.