Revenue Cycle Specialist III

What you'll be doing

The Revenue Cycle Specialist III (RCS-III) is responsible for working closely with the Supervisor and the RCS Manager to ensure that Business operations are working correctly and efficiently. The RCS-III is responsible for assisting insurance claims management by running Practice Management reports and reporting the finding to the supervisor and RCS Manager. The RCS-III must be committed to consistently modeling ERC Pathlight's core values and ensuring a positive, results-oriented, and reliable customer experience. The Revenue Cycle Specialist III is responsible for denial management functions for the revenue cycle department by monitoring and reporting on payor denial and slow-pay trends and conducting root-cause analysis. This position will interact and meet with teammates within the department who require assistance in effectively problem solving a specific account level denial, manage a set of assigned escalated accounts, and partner with department leadership and SMEs to develop and maintain denials management training and guidelines. This position requires both strong critical thinking and communication skills and will partner with management and teammates in Revenue Cycle, Patient Access, Utilization Review, Medical Records, Training & Process Optimization and Business Analysts teams.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Analysis
  • Analysis completed regularly utilizing available application systems (ex. Practice Management (PM), Electronic Data Interchange (EDI), Data Warehouse) to identify denied payor trends and patterns.
  • Root-cause analysis related to identified trends or specific escalated accounts and delivering recommendations for any necessary education and or process change(s) and share findings with leadership stakeholders.
• Accounts Receivable Insurance Claims Follow-up
  • Accountable for monitoring and resolution of specific accounts in delayed/open/unpaid status as assigned by leadership.
  • Call/Email Insurance Payors to resolve unpaid delayed/open/unpaid claims.
  • Navigating Insurance Payor portals to resolve unpaid claims.
  • Using denials management software (EDI), Updates and maintains denials trending reports for distribution to users
  • Process Medical Records Requests when needed.
  • Process requests for claim adjudication or additional adjustments when needed.
• Collaboration
  • Collaborate with teammates as needed to provide advice, consultation, observation, and training regarding claims management process, process changes and identified best practices (e.g. EDI utilization and optimization).
  • As appropriate, attend available payor webinars and trainings, monthly monitoring of payor websites/listservs for applicable notices, newsletters or process change notifications. Share learnings with teammates.
• Customer Service
  • Answer phone calls from insurance companies in the queue.
  • Assist other departments with patient concerns/questions when needed.
• Systems Maintenance
  • Submit Practice Management edits to Revenue Integrity Team & Data Business Analysts.
• EDI troubleshooting/User Support
• Help Onboard and train new teammates and support any knowledge transfer as needed
• Other duties as assigned

Required Qualifications:

• High School or GED
• 3-5 years of healthcare revenue cycle experience
• 2- 3 years' working knowledge of Medical EHR and Practice Management software
• Minimum of 2 years' computer experience working with Microsoft Office
• Problem solving and Conflict Management Skills
• Excellent organizational, planning, and decision-making skills. Pays attention to detail, and ability to prioritize
• Demonstrated ability to deliver assignments within a deadline

Preferred Qualifications:

• 3-5 yrs behavioral health, commercial and government payor revenue cycle experience

Location & Schedule:

**MUST WORK MOUNTAIN STANDARD TIME 8AM-5PM MST**

This position is posted as remote, but Denver, CO applicants are preferred and will be prioritized for interviews. In alignment with company policy, candidates who reside within a 35-mile radius of ZIP code 80230 will be expected to work a hybrid schedule:

• Remote: Mondays and Fridays
• On-site: Tuesdays, Wednesdays, and Thursdays