Overview
The Revenue Cycle Specialist is responsible for analyzing and monitoring claims audit data across multiple platforms to ensure accurate and appropriate reimbursement to healthcare providers. This role involves identifying payment variances and collaborating internally and externally to resolve discrepancies. This is a remote position.
Responsibilities
- Analyze and adjust/reprice claims to ensure reimbursement aligns with contractual agreements and payer guidelines
- Establish and maintain accurate pricing structures and rules to support competitive and profitable pricing strategies
- Identify errors in reconciliation files across multiple work streams, business units, and external partners
- Perform contract and reimbursement variance analysis
- Analyze claims data to detect contractual overpayments and billing errors
- Assist department and leadership in obtaining complex information from financial, clinical, and operational systems and data sources
- Stay current on billing protocols, federal and state regulations, and internal procedures affecting claims processing
- Provide subject matter expertise on billing and coding guidelines and regulations
- Use internal and external billing protocols for repricing bills to achieve cost savings
- Identify trends related to policies and procedures to improve efficiency and accuracy in bill processing
- Maintain detailed knowledge and documentation of all analysis and data sources within the department
- Analyze all forms of revenue cycle transactions
- Generate standard revenue cycle and operations reports to address inquiries from department/practice managers, vendors, physicians, and other stakeholders
- Produce daily, monthly, and annual evaluative and statistical reports analyzing variance drivers to ensure data integrity
- Evaluate client data integrity and support Product and Account Management teams with trend analysis of payment and data variances
- Ensure strict confidentiality of all medical records, protected health information (PHI), and personally identifiable information (PII)
- Perform additional duties as assigned
Requirements
- Minimum of 3 years relevant experience in claims repricing, pricing configuration, or provider maintenance, or equivalent combination of education and experience
- High School Diploma or equivalent required
- Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable
- Strong understanding of healthcare revenue cycle, claims reimbursement, claims processing, ICD-10 coding, and DRG validation (if applicable)
- Proficiency with MS Office applications including Word, PowerPoint, Excel, Outlook, Windows OS, and Internet
- Strong analytical, problem-solving, and critical thinking skills
- Excellent attention to detail and ability to deliver results in a fast-paced, dynamic environment
- Ability to work independently
Compensation & Benefits
- Pay range: $19.21 - $28.73 per hour, determined by factors including location, skills, experience, qualifications, and market conditions
- Salary level may be adjusted based on assessment during the interview process
- Comprehensive benefits package available for full-time regular employees, including medical (HDHP) with pharmacy, dental, vision, long-term disability, health savings account, flexible spending accounts, life insurance, accident insurance, critical illness insurance, prepaid legal insurance, parking and transit FSA accounts, 401(k), Roth 401(k), and paid time off
Location