Revenue Cycle Specialist Sr - Med Onc Support Services

Works collaboratively in a team environment to support the departments, surgical and clinical practices as well as TGH Radiation Oncology leadership on revenue cycle issues. Evaluates financial status, insurance / compensation coverage for Proton Beam Therapy patients. Serves as key resource in assuring the maximum reimbursement to the institution for required services, and in assisting Proton Therapy patients to obtain the resources to assure the standard of care necessary to maximize therapy success. Maintains and monitors financial transactions by assisting the Radiation Oncology Billing Manager, Clinical Leaders and Director of Radiation Oncology with day-to-day operations of payment posting, billing, and charge entry. Initiates and is responsible for identifying opportunities and recommend options for enhancing revenue and process efficiencies, while preserving TGH standards and minimizing the financial and legal risks to TGH Radiation Oncology. Actively participates in decision-making related to revenue cycle opportunities and is responsible for formulating and validating recommendations. Responsible for the duties related to the daily capture and review of all chargeable items. These functions are performed in accordance with all applicable laws and regulations and Tampa General Hospital's philosophy, policies, procedures and standards.

Essential Functions

A. Oversees the daily workflow to ensure all front-end revenue cycle processes are performed professionally and accurately.

B. Supervises and oversees training of support staff, including Front Desk Specialist and Financial Specialist, through all workflow processes to ensure

taff successfully understands their roles and associated responsibilities. Completes staff training, maintaining productivity standards and ensuring that

established goals and objectives are met or exceeded on a consistent basis.

C. Serves as a leader / trainer for other staff regarding clinical programs and policies to promote service and compliance consistency.

D. Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws. Educate and communicate

revenue cycle / financial information to patients, payers, providers, co-workers, managers, and others as necessary to ensure accurate processes.

E. Maintains functional and efficient billing / charging on a daily basis. Maintains billing log system to reach maximum reimbursement through accurate and timely billing procedures.

F. Verifies insurance benefits and compensation coverages by contacting insurance companies and employers to determine necessity for advance deposits, co-payments and deductibles. Identifies payor needs and information deficits and coordinates the provision of information to facilitate reimbursement

G. Develops and maintains financial references, including guidelines for reimbursement, state and federal regulations, payor-specific reimbursement policies. Develops and maintains TGH Radiation Oncology / Proton Center Reimbursement policies, procedures and resource material references. Updates third party payor reimbursement needs.

H. Establishes and maintains regular contacts with agencies offering financial aid; develops efficient processes / procedures for candidates to follow to complete the application process. Facilitates efficient communications for timely responses.

I. Assists patients with inquiries regarding financial / insurance issues through data collection, assessment and follow-up activities. Identifies appropriate resources to handle problems and complaints effectively.

J. Develops computerized database reports specific to Proton Center patients, including proton treatment tracking spreadsheet.

K. Reviews Documentation Requests sent by TGH Claims Follow-up team and provides requested information such as, but not limited to missing referrals, diagnoses, procedure codes, and other pertinent information required for claim submission.

L. Assists with the rejection reports; research reasons for denials, gathers requested data / documents to provide information to PUBS for claims re-submittal. Assist with the oversight of divisional charge rejection reports for the billing service. Acts as a liaison between the department and the billing office to ensure timeliness of turnaround for charge rejections.

M. Maintains functional and efficient billing / charging on a daily basis. Maintains billing log system to reach maximum reimbursement through accurate and timely billing procedures.

N. Actively communicate and present pertinent information to various audiences, particularly revenue cycle, practice and finance leadership. In addition, communication with senior leaders and formal TGH committees is expected. Uses reporting tools to understand risks and opportunities with significant impact to TGH Radiation Oncology and conveys these along with impact and recommendations to leadership.

O. Is recognized and relied upon as a subject matter expert in multiple revenue cycle areas who can recognize problems, formulate solutions and recommend changes in revenue, process efficiency and compliance areas. Responsible for the development, implementation and maintenance of complex programs and tools; the interpretation and implementation of new solutions; and identifies opportunities and recommends options for increasing financial margins.

P. Performs other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.

Qualifications

AA in Business, Finance, Accounting, or related field, or equivalent education and experience.

Bachelor's preferred.

A minimum of 3-5 years of experience working within a medical group billing department in a healthcare setting.

Excellent interpersonal & communication skills; high level of competence in customer relations in a professional environment; ability to prioritize, organize work and be self-directed; ability to work as a member of a team; ability to work in stressful situations; good problem-solving skills.