SUMMARY The Revenue Cycle Specialist â Outpatient Services is primarily responsible for the full-cycle billing process to ensure timely and accurate claim submission, follow-up, and collection of payment from payers, such as insurance carriers, patients, agencies and others, for services provided. The ideal candidate has demonstrated ability to produce high-quality analysis, recommendations, and documentation. This position requires exceptional communication and interpersonal relationship skills and the ability to work with minimal supervision. ENTRY REQUIREMENTS: Associates degree required. Bachelorâs degree in Business Administration, Healthcare Administration or related field preferred. Minimum of three (3) years previous medical office, customer service, or related experience required. Knowledge and/or past experience related to insurance reimbursement. Outpatient program experience and customer service background desired. Proficient with computers in a healthcare business setting (including spreadsheets) and calculating numerical figures. Outstanding grammar, spelling, formatting, medical terminology, and punctuation skills. ORGANIZATION: This position is under the direct supervision of the Director of the Outpatient Services. Maintains a close working relationship with all members of the Outpatient Services leadership staff. Receives project work through the Director of Outpatient Services. Identifies and prioritizes projects to achieve Department and Division goals. SPECIFIC DUTIES 1. Supports the Mission, Vision and Values of Munson Healthcare. 2. Embraces and supports the Performance Improvement philosophy of Munson Healthcare. 3. Promotes personal and patient safety. 4. Uses effective customer service/interpersonal skills at all times. 5. Maintains and promotes a strong relationship between the Outpatient Services departments, Revenue Cycle, Corporate Compliance, and Patient Financial Services (Business Office/Patient Accounts) departments regarding reimbursement issues. Develops and maintains working relationships with other MMC departments to improve patient service and department processes. 6. Stays updated regarding compliance, reimbursement, and documentation changes for all areas within Outpatient Services, including OPPS Rules, CMS Guidelines, etc. Communicates and works closely with the Leadership to establish educational sessions that will assist in keeping staff up-to-date regarding documentation requirements and changes. Attends department staff meetings when requested to provide feedback regarding reimbursement and changes/updates in documentation requirements. 7. Works closely with the Patient Access Services, Patient Financial Services, and Corporate Billing Office to meet requirements of payers and regulatory agencies. Manages rejection and denial reports and works with department staff to resolve issues. Provides education to leadership and staff when requirements change. 8. Works with departments to ensure authorization, documentation, and medical necessity requirements are met. In some cases, performs chart reviews and audits, and pursues prior-authorizations, to support real-time decision making for departments seeking to perform procedures or treatments. 9. Works with Information Systems as needed for troubleshooting, design, reporting, etc. related to systems used in Outpatient Services 10. Submits Charge Master changes, additions, and deletions for new and existing departments. Meets annually with the Revenue Cycle Team to review current charge masters and identify new HCPCS codes or opportunities for increased revenue. Instructs and supervises departments in the implementation of any new codes and billing procedures. 11. Assists departments in process redesign, problem resolution, resource utilization, as well as billing, reimbursement, and insurance issues. 12. Performs other duties and responsibilities as assigned.
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