Revenue Cycle Specialist

Position Overview The Revenue Cycle Specialist is key to department success because s/he focuses on the processes that impact both the revenue cycle at Oregon Specialty Group and our patient’s ability to pay for care. The incumbent uses automated systems to complete all revenue cycle workflows to reduce AR aging. The position’s objectives are to maximize process and performance efficiencies, reduce operational costs, increase accuracy, and improve reimbursement outcomes. The position is full time. The schedule is Monday-Friday 7:30am-4pm with a 30 minute lunch.

Essential Job Functions

• Prepare, review, and transmit claims using billing software to include electronic and paper claims processing both primary claims and secondary claims
• Work with insurance providers to resolve disputes over coverage, coding, prior authorization, and non/underpayment issues
• Research and compile the necessary documentation, and complete appeal processes for denied claims, via phone/email with payers, facilitating corrected claims if necessary
• Follow up on unpaid claims within standard billing cycle timeframe
• Collaborate with the coding and prior authorization teams when necessary to make coding and prior authorization changes to submit corrected claims or appeals.
• Stay current with payer trending regarding how to submit corrected claims and the payer-specific appeal processes, including timely filing and prior authorization guidelines; apply current guidelines to all submissions
• Ensure that billing practices comply with regulations such as HIPAA (Health Insurance Portability and Accountability Act) and other federal, state, and local healthcare laws
• Ensure that payment posting policies, procedures, and systems are current and accurately utilized
• Post payments received from insurance companies and patients to the patient accounts, ensuring accuracy in payment posting; deposits are posted daily by 11:00 AM
• Work closely with other departments (clinical, accounting, coding, prior authorization, and financial counseling teams) to ensure smooth revenue cycle operations
• Other duties as assigned by the Revenue Cycle Manager

Required Qualifications

• High School diploma or equivalent
• Two years of experience in a healthcare revenue cycle role
• One year of experience optimizing processes and software to improve AR outcomes
• Two years of experience with medical insurance terminology, CPT, ICD coding structures, and billing forms
• Knowledge of high-functioning EHR, billing systems, and applications (iKnowMed, Lynx, Centricity, Epic, etc.)
• Verbal and written skills – Ability to convey reasoning clearly and persuasively to patients, team members, and insurance payers
• Ability to logically and accurately analyze details
• Demonstrated research and resolution related to denial management
• Excellent PC operating skills and use of MS Office

Preferred Qualifications

• Associates degree in applicable field
• Experience with Oncology billing
• Understanding of Unlimited Systems Revenue Cycle Software

A successful Revenue Cycle Specialist will…

• Enjoy interacting with a variety of people, making the best of each interaction.
• Practice the balance of cooperation and urgency daily
• Develop and unite partnerships with internal and external associates to accomplish better systems and outcomes
• Create and maintain regular and reliable measures of team performance and success
• Possess extraordinary critical thinking and organizational skills
• Be a self-starter who can influence positive change
• Possess unrelenting determination
• Thrive in team environments