The Revenue Cycle Specialist I 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 actionSubmit carrier appeals and reconsideration requests in a timely manner based on SOPs or make suggestions to enhance SOP'sReview 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 completenessEnsure all relevant claims and appeal documentation is uploaded into OnBaseVerify all identified insurance carriers for policy related to prior authorization requirements as needed for claims adjudicationWork collaboratively with other Coding, Billing, Patient Access, and Cash Receipts Specialists as neededSuccessful Candidates Must Possess :
High School diploma or GED required; Associate's or Bachelor's Degree in Business, Finance, or related discipline preferredWith a High School diploma, a minimum of three (3) years of experience performing revenue cycle processes in a hospital, laboratory, ambulatory surgery center, or large medical practice required; With a Bachelor's degree in Finance / Accounting, no experience requiredKnowledge of ICD9, ICD10, CPT, and HCPCS coding strongly preferredStrong working knowledge of Microsoft Office, including Excel and OutlookAbility to take direction and follow Standard Operating Procedures with a high degree of accuracyStrong attention to detail and the ability to work in a fast-paced, team-oriented environment with a focus on communication requiredAegis Sciences Corporation is an Equal Opportunity Employer