Revenue Cycle Specialist

Job Summary :

The Revenue Cycle Specialist is responsible for analyzing data for Key Performance Indicator (KPI) monitoring and reporting to help reduce financial risk and improve financial performance. Provides information to ensure compliance of registration policies and procedures and regulatory requirements. Monitors registration staff's performance across the system to identify benchmarks and goals; investigate, provide root analysis when necessary, and to create and implement general course correction as appropriate. Develops and implements strategies to facilitate continuous operational improvement across the health system impacting services across the system for all aspects of registration including functions within professional and hospital billing. Assists in developing and leading end user department learning in both formal / classroom style training and informal / elbow support training. Responsible for audits / analysis and outcome assessments for accuracy of patient data, both system-related and process-related for registration, billing, and operational areas that impact patient registration, billing, and / or collections. Helps support revenue cycle initiatives across the system within registration and billing departments. The Revenue Cycle Specialist reviews appropriate reports and systems to monitor patient account errors and track trends for timely resolution. Responsible for ongoing reports to leadership as defined by each owning area. Works closely with Erlanger's eChart team, Organizational Learning, operation leadership, payers, and third-party applications to ensure consistency across the health systems to conduct assigned activities.

Education : Required :

High school graduate / GED

Preferred :

B.S. Business or Healthcare related field

Experience : Required :

Two years' work experience in a complex and high-volume healthcare setting in a registration, precert and / or billing capacity such as PAS or PFS. Fundamental knowledge of insurance processes is necessary as well as experience with direct contact with patients. Demonstrated ability and interest to mentor and teach all types of learning styles. Demonstrated ability to work effectively in a fast-paced environment, build positive relationships, and remain flexible under stressful situations.

Preferred :

Experience in a supervisory and / or training capacity is preferred. Experience in both hospital and professional healthcare setting is preferred. Analytical and reporting skills. Experience using Excel and PowerPoint Microsoft products. Epic experience preferred.

Position Requirement(s) : License / Certification / Registration

Required :

N / A

Preferred :

Certified Healthcare Access Management (CHAM)

Department Position Summary :

Under the direction of the Revenue Cycle Operations Manager and Revenue Cycle Director, the Revenue Cycle Specialist analyzes performance data to assist revenue cycle management and operational management with performance accountability. Provides daily, weekly, and monthly reporting for leadership to track performance. Develops and creates new reports as requested and analyze data to identify gaps and provide recommendations to leadership for improvement. Reports issues identified during the audit process and recommends changes to improve outcomes. Monitors upfront collections, work queues, denials, and complete special projects as assigned. Tracks KPIs and communicate to applicable leadership within assigned timeframes.

Provides support for initiatives and projects that impact the revenue cycle. Work with IT and other departments to test software upgrades and changes before department wide implementation. Supports third-party application changes and communication from an operational perspective. Maintain knowledge of commercial and government insurance plans, hospital and physician-based regulations and billing requirements to ensure proper compliance of registration departments. Assists in payer plan updates to include : admission notifications, prior authorizations, insurance card changes, plan selection, and contract requirements. Reviews registration and cashiering documentation to identify patterns and trends requiring attention to meet departmental and federal standards. Assists and supports the implementation of process improvements across the health system for revenue cycle.

Develops and implements instructional materials such as tip sheets, email information, presentations, and EOL-based learning that supports revenue cycle front-end processes across the system. Develops and maintains Revenue Cycle policies and procedures to provide guidance across the health system impacting services in the inpatient, ambulatory, and physician practice settings for all aspects of front-end processes. Perform audits and reports per policies. Develops and administers staff development and course content initiatives, annual staff competencies, and other programs as needed. Develops informational material to reduce or eliminate registration errors based on current patterns and trends, in collaboration with Organizational Learning.

Develops and provides ongoing communication venues for frontline staff to ensure Revenue Cycle goals are met. Identifies quality deficiencies in front-end areas by discovering trends in system work queue edits (Patient, Referrals, Charge Review, Claim Edit, and Denials). Conducts routine and ongoing rounding in assigned departments which includes clinic and facility locations. Provides frontline support as directed by leadership. Reports specific trending issues. Provides PAS specific support through email requests from frontline staff. Implements programs to address deficiencies while maintaining consistency across the health system. Participates in Epic build changes in collaboration with Erlanger's eChart IT team(s). Conducts workshops with Erlanger eChart / Build teams, Organizational Learning / PAS leadership for areas with specific concerns or needs. Provides onboarding content information for new employees.

Provides ongoing support to operational leaders. Supports Revenue Cycle leaders in developing short- and long-range strategic goals and objectives and assists in implementing initiatives that strive to meet strategic goals. Resolves work queue edits. Serves as a backup to frontline operations during abnormal operations.