Three to five years of healthcare experience in a managed care setting is required.
Proficiency in data analytics, including SAS and SQL, is required.
Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting is required.
Knowledge of CPT, ICD-9, ICD-10, HCPC, DRG, Revenue, and RBRVS is required.
Proficiency in Microsoft Excel, Word, and PowerPoint, and experience using a claims processing system or comparable database software, are required.
Effective oral, written, and interpersonal communication skills are required.
Ability to multitask efficiently, effectively, and in a timely manner is required.
Strong organizational skills and work ethic are required.
Must be able to meet the stated physical requirements, including standing, sitting, lifting or pushing/pulling up to 50 pounds, bending or squatting, using stairs and walking, fine motor tasks, visual and audio tasks, and cognitive functions needed for the job.
Responsibilities
Perform weekly billing for Best Choice/Matter of Care in coordination with Coordinators and Payroll.
Enter and independently reconcile insurance and member payments to accounts receivable.
Perform full analytics on all revenue operations for all lines of business of CenterLight.
Perform analytics on MMR and 820/834, and reconcile payments received to billing files.
Independently investigate and resolve Enrollment/Intake discrepancies for correction or rebilling.
Coordinate with Enrollment on PDE rejections and assist the Enrollment team with CMS-related issues.
Coordinate with Enrollment on MSP letters and correct discrepancies in ECRS.
Identify members with Surplus, NAMI, or Pool Trust balances and resolve related issues.
Work with the Enrollment/Intake team to resolve eligibility issues.
Perform monthly MMR analysis and work with the CMS MAPD Helpdesk to open and resolve tickets.
Coordinate with dialysis providers to obtain 2728 forms and work with the CMS MAPD Helpdesk to activate member ESRD indicators.
Prepare monthly general ledger entries related to revenue.
Assist Actuarial with data analytics as needed.
Develop and maintain financial reporting and analytics in Tableau and Power BI, including KPI dashboards used by senior leadership to track actual results against targets.
Prepare ad hoc financial modeling, analysis, and projections.
Serve as a resource and informal mentor to Revenue Cycle Analyst I staff on daily tasks, tools, and procedures.
Contribute to process improvement initiatives and document standard operating procedures.
Create SQL queries and stored procedures for use by other team members.
Develop a process to identify revenue-enhancing opportunities.
Work on special projects as assigned.
Desired Qualifications
Claims adjudication experience and understanding of claims PPS are strongly preferred.
Certified Professional Coder certification is a plus.
JOB PURPOSE:
This position is responsible for CenterLight’s billing and revenue cycle analysis, reconciliation, and operational procedures while maintaining adherence to DOH and CMS guidelines. This position independently manages day-to-day revenue cycle operations, reporting on revenue cycle functions, and provides guidance to Revenue Cycle Analyst I staff.
JOB RESPONSIBILITIES:
Perform weekly billing for Best Choice/Matter of Care in coordination with Coordinators and Payroll.
Enter and independently reconcile insurance and member payments to A/R.
Perform full analytics on all revenue operations for all Line of Business of Centerlight.
Perform analytics (on MMR and 820/834) and reconciliation of payments received to billing files.
Independently investigate and resolve Enrollment/Intake discrepancies for correction/rebilling.
Coordinate with Enrollment on PDE rejections and assist the Enrollment team with CMS-related issues.
Coordinate with Enrollment on MSP letters and correction of discrepancies in ECRS.
Identify members with Surplus, NAMI, or Pool Trust balances and resolve related issues.
Work with the Enrollment/Intake team to resolve eligibility issues.
Perform monthly MMR analysis and work with the CMS MAPD Helpdesk to open and resolve tickets.
Coordinate with Dialysis providers to obtain 2728 forms and work with the CMS MAPD Helpdesk to activate member ESRD indicators.
Prepare monthly GL entries related to revenue.
Assist Actuarial with data analytics as needed.
Develop and maintain financial reporting and analytics in Tableau/Power BI (including KPI dashboards) used by senior leadership to track actual results vs. target.
Prepare ad hoc financial modeling, analysis, and projections.
Serve as a resource and informal mentor to Revenue Cycle Analyst I staff on daily tasks, tools, and procedures.
Contribute to process improvement initiatives and document standard operating procedures (SOPs).
Create SQL queries/ store procedures for use by other members of the team.
Work of developing process to identify revenue enhancing opportunities.
Work on special projects as assigned.
Schedule: Monday - Friday | 8:30AM – 5:30PM
Weekly Hours: 40
QUALIFICATIONS:
Education: Bachelor's degree required. Certified Professional Coder a plus.
Experience:
3-5 years of healthcare experience, managed care setting is required.
Proficiency in data analytics, i.e. SAS, SQL is required.
Claims adjudication and understanding of claims PPS is strongly preferred.
Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting is required.
Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS.
Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software.
Effective oral, written, and interpersonal communication skills are required.
Able to multitask efficiently, effectively, and timely.
Strong organizational skills and work ethic.
Detail-oriented, professional and collaborative, a great team player.
Physical Requirements
Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to:
Standing – Duration of up to 6 hours a day.
Sitting/Stationary Positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.
Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc.
Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job.
Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas.
Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.)
Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy.
Audio Hearing and Motor Skills (Language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.
Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.
Disclaimer:Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.
We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.
Salary Range (Min-Max):
$80,000.00 - $90,000.00
Every application is reviewed by our recruitment team. We do not use AI to make hiring decisions or automatically reject applicants. All employment decisions are based on job-related qualifications and applicable employment laws.