The Revenue Operations Specialist is responsible for optimizing revenue-related processes and systems to include pre-billing claim review, claim follow-up & denials management. Carries out in-depth analysis of claim review, provides insight and feedback on issues/trends identified in the revenue cycle process. Incumbent is responsible for providing data and understanding necessary to support decision making, project prioritization, and improvements across revenue cycle.
- Works independently to review encounters (insurance) prior to coder review
ensuring all ancillary charges and results are entered based on orders & visit
- Documents trends in missing documentation and provides weekly
report to Clinical & Clinical Administration Directors.
- Uses NextGen AR Aging Report to ensure timely payment from third-party payers
by daily follow-up on claim status utilizing phone or online resources (15, 30, 45-day
- Is responsible for working claim denials.
- Performs trend analysis of payer claim rejections and denials in collaboration with
Patient Account Services Coordinator and Patient Financial Counselor.
- Serves as coder liaison for encounter/coding needs from providers (in conjunction
with coders) to assist with timely claim submission.
- Serves as a back-up to Care Coordinator
- Use internal and external resources such as claims data, population health
software, and the EMR to collect data on quality metrics and track as required for
improvement efforts to the assigned patient population
- Participate in process/quality improvement initiatives to achieve targets as defined
by organizational goals and objectives
- High school diploma, GED, or suitable equivalent and completion of Medical Billing/Coding program.
SPECIAL SKILLS & KNOWLEDGE
- Three or more years working in an outpatient ambulatory setting with a focus on insurance and medical billing. Must be familiar with medical terminology.
- Basic computer skills are essential; experience with a medical practice management system and electronic medical record are preferred.
- People skills: verbal and written communication abilities should be well-developed, customer service and interpersonal skills should be proven
- Administrative skills such as organization, project planning, and time management are important to be successful in this position.
- Customer service skills and the ability to work with payers and colleagues in a calm, polite manner.
Job Type: Full-time
Pay: From $34,912.00 per year
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Ability to commute/relocate:
- Memphis, TN 38104: Reliably commute or planning to relocate before starting work (Required)
- Fraud: 1 year (Preferred)
- Microsoft Excel: 1 year (Preferred)
- SAP Finance & Controlling: 1 year (Preferred)
Work Location: In person