Senior Revenue Cycle Specialist

Senior Revenue Cycle Specialist

A Senior Revenue Cycle Specialist is a member of the Revenue Cycle team within the Yield Management Division. This department may work directly with other members of Yield to ensure department expectations are accomplished. The Sr. Specialist, Revenue Cycle position is responsible for complex levels of recurring and / or daily functions and processes that are necessary for business execution; including but not limited to, ensuring the quality of various functions within the department (check application, offsets, invoicing, etc.). Other responsibilities will include solving complex issues that have been identified and being a point person for other Revenue Cycle Specialists within the department. A Senior Specialist will identify discrepancies, analyze issues to ensure payments are posted timely and process electronic requests in multiple systems and platforms.

Additionally, a Senior is a subject matter expertise and works directly with the Team Lead to ensure the success of the team in creating and identifying training materials and assisting with new hire onboarding and orientation, acting as a mentor for others on the team.

Responsibilities

• A Senior Specialist is identified as a subject matter expert on all knowledge within the Revenue Cycle space.
• Collaborate with the Team Lead to develop and oversee new hire onboarding materials, ensuring the effective training of Specialists and Specialist 2's.
• Completes or monitors organizational functions or processes, ensuring that they are completed accurately, on time, and in compliance with established policies and regulations.
• Tracks processes, preparing reports for management detailing quality or quality of departmental actions.
• Analyzes, identifies, and implements procedural change opportunities to improve performance and efficiency, and maximize revenue or margins.
• Ability to resolve errors and handles exceptions of limited risk and complexity.
• Identifies opportunities to improve revenue cycle processes and proposes solutions to capitalize on opportunities. Works with manager to establish an implementation plan and can work independently or with support of Specialists to implement plan. Thinks critically through implementation of plans to identify gaps and make necessary adjustments.
• Serves as a key point of contact for other departments on the audit and the client. Resolves client and audit issues to completion with attention to detail and the highest level of professionalism. Conducts research and resolution on outstanding claims. Posts adjustment transactions to collection system as well as client's system.
• Posts payments to collection accounts, reconciles with posted bank transactions, works with AP department to have refund issued when needed, reconciles monthly bank statements with cash posting database. Posts adjustment transactions to collection system as well as client's system.
• Access and understand necessary information from the various online systems, understanding the systems process in determining how a claim has been paid to accurately apply payments and adjustments and assists in determining the adjudication of funds. Has a detailed understanding of client systems and processes. Can serve as a subject matter expert on client processes.
• Prepares and records financial transactions for assigned accounts to accumulate and record accurate and timely financial history. Ensures monthly reporting for audit purposes. Prepares and records financial transactions for assigned accounts to accumulate and record accurate and timely financial history. Ensures daily deposit reconciliation; maintains daily, monthly reporting for audit purposes.
• Researches and accurately distributes payments with no apparent invoice number, or date-of-service. Researches and determines the correct claim for the payment if there is a valid patient / date of services and accurately applying payment to correct claim.
• Maintains thorough and detailed knowledge of compliance and recovery laws regarding processing and recoupment to ensure compliance with state laws regarding all cash processes as evident through the collection cycle.
• Maintains productivity goals and standards set by the department. Ensures all department rules and processes are followed. Alerts manager of system issues or other issues impacting productivity.
• Quickly grasps a working understanding of basic elements and concepts of audit operations. Demonstrates enthusiasm for learning and applying knowledge to the completion of tasks. Successfully integrates and executes new assignments with moderate guidance and direction.
• Demonstrates adeptness in gathering data, analyzing problems, evaluating options, and developing / implementing creative solutions to job challenges. Makes logical, well-reasoned and timely decisions, seeking guidance and support as appropriate.
• Demonstrates competency with tools of the job including but not limited to filing systems, computers, word processing & spreadsheet applications, web systems, Cotiviti and Client systems, data file structures and Power Point. Can efficiently download and format common file types.
• Demonstrates ability to plan, organize, and prioritize multiple tasks and ensure timely completion. Uses a structured and dependable approach to accomplishing assigned work.
• Shows initiative and a willingness to engage in all audit support activities. Reaches beyond current tasks to add value to broader team. Goes the extra step to solve problems instead of waiting for someone else to solve them.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Assures confidentiality and security of all data, adhering to all HIPAA laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.
• Works with clients, customers, and partners to accurately assess their needs, provide information or assistance, resolve problems, or satisfy requirements.
• Can be counted on to consistently meet or exceed goals and perform at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.

Qualifications

Mental Requirements :

Physical Requirements and Working Conditions :