Senior Revenue Cycle Specialist

Job Summary

The Senior Revenue Cycle Specialist is responsible for providing support and guidance to the daily activities of the Revenue Cycle Department to ensure efficient, timely, and high quality performance. This includes developing guidelines, distributing work, reviewing quality findings, proactive communication, and helping to resolve problems. This position is also responsible to review and process claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for assigned clients.

Major Responsibilities/Activities

• Monitor overall client performance for the team, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients.
• Conduct monthly audits for team members.
• Proactively monitor, communicate, and make recommendations regarding team performance, patterns, deficiencies, and/or areas needing improvement and provide appropriate feedback to direct supervisor and/or Operations Manager in order to reduce and prevent future problems.
• Develop and communicate innovative ideas to improve overall team performance and processes; implement ideas as directed. Continuously look for ways to improve processes and streamline to better serve clients and assist staff in day to day operations.
• Respond to questions in a timely and professional manner.
• Participate in cross-functional meetings to provide input on client issue resolution and continuous improvement efforts.
• Maintain a consistent workflow among the team and proactively notify appropriate individuals/departments if problems, trends, or obstacles arise.
• Assist in providing ongoing training and communication to team members regarding department information, goals, and performance. May also assist with scorecard process.
• Conduct all job tasks, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations.
• Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues. 
• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim.
• Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion.
• Effectively communicate with team members to ensure highest level of reimbursement is achieved through effective prioritization of work and adherence to established standard operating procedures.
• Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though.
• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness. 
• Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs.
• Consistently support and demonstrate the company mission and values.
• Initiate and participate in self and career development discussions, initiatives, and goals. 

Other Responsibilities/Activities

• Remain informed and prepared to present client performance analysis as needed and directed 
• Assist with special projects related to billing operations, government regulations, etc. as directed
• Conduct training with appropriate staff as required for process improvements, knowledge gaps, or industry changes
• Serve as backup to other teams members as required
• Research and respond to inquiries in a timely and professional manner
• Perform other necessary tasks as assigned by supervisor

Performance Requirements

• Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service Level Agreements, A/R Aging, Net Collection Percentages, and Average Cash Per Trip, Denials, Rejections, Account Review Aging and maintaining a 96% audit score monthly.

Required Education, Skills, & Experience

• High School Diploma
• At least 1-2 years’ experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience
• Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though 
• Ability to organize, prioritize and multi-task  
• Ability to learn, understand, and work within specific compliance, client, and payer requirements
• Approach all tasks, duties, and interactions with an attitude of continuous improvement
• Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties
• Ability to function well within a cross-functional team setting and independently
• Demonstrated operational communication skills; written and verbal
• Detail-oriented
• Resourceful
• Self-starter
• Must possess critical thinking/analytical skills
• Proficient in Microsoft Office programs

Preferred Education, Skills, & Experience

• Strong preference for prior EMS billing and/or denials experience
• Proficient in EMS|MC billing software

Working Environment/Physical Requirements

• General office environment
• Frequent typing
• Sitting, standing, walking
• Use of basic office equipment such as computer, fax, printer, copier, and telephone

*Please note, our hiring process typically lasts 2-4 weeks with three to four interviews total.*