Revenue Cycle Specialist

You know that your job is about much more than gathering referral and payer information. As a Revenue Cycle Specialist, you are the important link between patients and physician referrals. You are the calm presence that provides all parties with the information they need for the best possible experience. You treat all parties with the dignity that is a hallmark of the Legacy community. If this describes you, we’d like you to consider this opportunity.

The Revenue Cycle Specialist (RCS) provides on-site support to patients, providers and staff regarding all facets of physician referrals and revenue cycle for patient services. The RCS will act as the on-site reviewer to ensure that charge-coding meets the guidelines set by Medicare and other payers. S/he provides feedback to providers and assists Coding/Compliance Analyst in development and presentation of coding education, referral education and updates.

Responsibilities

REFERRALS : Processing of all referrals and prior authorizations (hereafter referred to as ‘referral’) to ensure timely handling in order to meet the department’s financial, customer service and regulatory standards.

Provides education and customer service to providers, staff and patients regarding the department referral process.

Provides data entry and clerical support for the referral process for both pre-paid and fee-for-service health plans.

Understands each health plan’s guidelines, benefits and basic risk models. Maintains current knowledge of referral process and shares information with staff and providers.

Verifies patient eligibility and/or benefits, follows up with patient and health plan to determine that the patient is covered.

Understands and follows department’s referral processes and procedures.

Identifies and resolves patient, provider, department and insurance company concerns, requests and problems related to referral issues.

CHARGE CAPTURE/FEE TICKETS : Monitors charge capture/fee ticket process to ensure timely handling in order to meet the department’s financial, customer service, and regulatory standards.

Provides assistance and direction to providers and staff on missing, incomplete or inaccurate charges.

Assists providers and staff in assigning appropriate Diagnosis and CPT codes and researching problems and/or concerns as needed.

Reviews charges and documentation to ensure appropriate use of CPT/Diagnosis coding practices. Acts as a liaison between providers and revenue cycle departments.

Verifies that all billable visits have charges attached.

Works assigned Charge Review Work Queue’s and inpatient reconciliation report in a timely manner.

KEY POINT: Revenue Cycle includes Patient Access, Medical Records, Billing.

LIAISON TO BILLING DEPARTMENT: Acts as liaison between department staff, providers and billing department.

Identifies areas of need within the revenue cycle process and facilitates resolution of revenue cycle issues with billing department and department manager.

Identifies areas of need for provider education in coding and documentation and conveys information to Coding/Compliance Analyst.

Serves as a liaison with credentialing department to notify office staff regarding provider credentialing status.

Other

Additional functions may include but is not limited to:

Handles person-to-person patient inquiries regarding billing issues. Communicates patient concerns to billing office staff.

Identifies patient, provider, department and insurance company concerns, requests and problems related to billing issues and communicates them to the billing team as appropriate.

May assist with cash handing.

Education

Qualifications

Associate’s degree in business or healthcare, or equivalent experience, required.

Experience

Computer knowledge and keyboarding experience required. Demonstrated knowledge of CPT and Diagnosis coding required. Knowledge of managed care practices preferred.

Skills

Strong written and verbal communication and interpersonal skills.

Ability to analyze information and make decisions using reasonable and logical judgment.

Ability to problem solve in a professional manner.

Ability to present information and feedback in a concise and understandable manner.

Ability to work collaboratively with staff to resolve issues for patients and providers.

Ability to read and understand medical terminology.

Keyboard skills and ability to navigate electronic systems applicable to job functions.

Legacy’s Values In Action

Follows guidelines set forth in Legacy’s Values in Action.

Equal Opportunity Employer/Vet/Disabled