Job Responsibilities:
- Serves as a source of knowledge for the designated revenue cycle functions.
- Facilitates and manages the full life cycle of the claim process.
- Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.
- Works with IT to oversee system administration for database application, testing, user administration, security access and end-user training.
- Responsible for billing software maintenance and installation of upgrades.
- Responsible for developing appropriate workflows and tracking for the designated revenue cycle function.
- Establishes an ongoing working relationship with other departments impacting revenue cycle performance.
- Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement.
- Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
- Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
- By continually reviewing and monitoring billing and coding changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
- Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance.
- Develops goals and metrics to link department and revenue cycle initiatives with the organization’s strategy.
- Develops, manages and monitors successful completion of implementation and project plans.
- Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.
- Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success.
Qualifications:
- At least 3 years of experience in medical billing and Insurance collections
- Strong proficiency in SQL, PowerBI and Excel
- At least 3 years of experience with Prior Authorization requirements, payer utilization management policies and Appeals