Overview
A healthcare payments organization specializing in clinical and cost containment solutions is seeking a Revenue Cycle Specialist I. This role is essential for ensuring accurate reimbursement by analyzing and repricing claims in accordance with contractual agreements and payer guidelines. The position supports financial integrity through error identification, variance analysis, and maintenance of pricing structures.
Responsibilities
- Analyze and reprice claims to ensure accurate reimbursement rates per contracts and payer guidelines
- Establish and maintain pricing structures for competitive and profitable claims processing
- Identify errors in reconciliation files across multiple sites and external partners
- Perform contract and reimbursement variance analysis
- Detect contractual overpayments and billing errors through claims data analysis
- Support leadership by obtaining complex information from financial, clinical, and operational systems
- Stay current on billing protocols, federal and state regulations, and internal procedures
- Provide expertise on billing and coding guidelines as needed
- Use billing protocols to reprice bills and achieve cost savings
- Identify trends to improve efficiency and accuracy in bill processing
- Maintain documentation of analysis and data sources within the department
- Analyze all forms of Revenue Cycle transactions
- Generate standard reports for department managers, vendors, physicians, and stakeholders
- Produce evaluative and statistical reports to monitor revenue cycle data integrity
- Support Product and Account Management teams with trend analysis of payment and data variances
- Ensure strict confidentiality of medical records, PHI, and PII
- Perform additional duties as assigned
Requirements
- Experience in claims repricing, pricing configuration, or provider maintenance required
- Minimum of 3 years relevant experience or equivalent education and work background
- High School Diploma or equivalent required
- Knowledge of CMS guidelines and ICD-10 coding guidelines as applicable
- Detailed understanding of pay reimbursement methodology
- Strong knowledge of claims processing, ICD-10 coding, and DRG validation (if applicable)
- Proficiency with MS Office (Word, PowerPoint, Excel, Outlook) and Windows OS
- Strong analytical, critical thinking, and problem-solving skills
- High attention to detail and ability to work effectively in a fast-paced environment
Compensation & Benefits
- Pay Range: $19.21 - $28.73 per hour, dependent on location, skills, experience, qualifications, internal equity, and market conditions
- Level placement (I, II, III, Senior, Lead) may be adjusted based on assessment during the interview process
- Comprehensive benefits package for full-time employees including Medical (HDHP) with Pharmacy, Dental, Vision
- Long Term Disability, Health Savings Account, Flexible Spending Account Options
- Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K and ROTH 401K plans
- Paid time off
Location
Remote work opportunity
Equal Opportunity
The employer is an equal opportunity organization committed to diversity and inclusion. All qualified applicants will receive consideration without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.