Revenue Cycle Operations Specialist

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Performing a broad range of medical billing functions that cover an enterprise-wide scope, the Revenue Cycle Operations Specialist role is responsible for identifying, researching, and resolving various Professional and Hospital billing issues for all commercial and government payors. The Revenue Cycle Operations Specialist’s duties primarily involve registration error, coverage, and eligibility related front-end edits and denials for both Professional and Hospital Billing. Additional tasks for Professional Billing include the resolution of external clearinghouse edits, payor claim rejections, and disputed self-pay account balances. The role also includes frequent review and analysis of registration related issues and errors as well as education to reduce errors and denials and increase professional revenue.

Job Description:

Essential Duties & Responsibilities including but not limited to:

Essential Duties & Responsibilities including but not limited to: 
1.    Ensuring proper resolution of all registration, coverage, and eligibility related issues captured within the following Epic billing work queues:
•    Charge Review and Claim Edits queues are used to resolve errors prior to claims submission and prevent denials.
•    Professional & Hospital Billing Denial queues that require insurance follow-up on coverage, eligibility, and coordination of benefits related denials in order to have each denied invoice reprocessed and reimbursed.
•    Retro Review (Professional Billing) and Coverage Change Manager (Hospital Billing) queues to catch and apply potential retroactive coverage changes to outstanding visits, such as newly added coverages or filing order updates.
•    Remittance posting queues to properly match payments and eliminate undistributed credits by resolving invalid payor errors on a daily basis.
•    Account queues that hold disputed self-pay balances that have been escalated for further billing review.
2.    Under the guidance of the Department Manager and Supervisor and in accordance with departmental policies and standards, each Billing Specialist is expected to prioritize and maintain their daily assignments by applying filter and sort methods to their Epic billing work queues.
3.    Responsible for independently and accurately posting all manual adjustments as necessary and selecting the appropriate adjustment codes. Adjustments exceeding certain situational thresholds as defined by department leadership will be sent to the Senior Manager for final review and approval.
4.    Responsible for the resolution of all external clearinghouse edits and payor rejections.
5.    Makes necessary updates to the Epic patient registration and identifies opportunities to initiate rebilling of an entire account or multiple accounts associated with the same patient even if additional charges, claims, or denials are not currently captured on their active work queue list if it is deemed appropriate and if the end result produces a desirable and optimal outcome for both the department and the patient.
6.    Attends and actively participates in monthly conference calls with an assigned physician group to provide operational billing support and ad-hoc work queue training. Fields front-end user inquiries and provides accurate and timely responses.
7.    Responsible for performing a rigorous and detailed review of disputed self-pay account balances for complex billing scenarios that have been escalated by Customer Service after going unresolved.
8.    Works with departments throughout the organization, third-party vendors, and insurance carriers to resolve issues related to registration and customer inquiries.
9.    Maintains a proficient level of knowledge of Physician and Hospital Billing regulations and requirements.
10.    Experienced with reading and interpreting CMS1500 and UB-04 claim forms.
11.    Works with Hospital, Professional, and Customer Service departments to identify improper billing trends through root-cause analysis.
12.    Working in an SBO (Single Billing Office) environment the Revenue Cycle Operations Specialist will need to have in-depth knowledge of Hospital and Professional Billing workflows in order to assist with customer questions and accurate registration of insurance.
13.    Proactively identifies problems and opportunities for improvements related to system usage, training, end-user education, practice, and user trends and makes recommendations for workflow optimization and denial prevention.
14.    Collaborates with Revenue Cycle Analysts to validate observed patterns and trends with supporting data captured in Epic application and workbench reports.
15.    Assists in the development of reporting mechanisms to identify trends and track so that education can be performed to reduce and/or resolve high dollar/high volume values.
16.    Completes all assignments in accordance with department policy the department standards.
17.    Attends meetings and serves on committees as requested.
18.    Achieves exemplary audit results and consistently exceeds productivity standards.
19.    Provides and promotes ideas geared toward process improvements within the Central Billing Office.
20.    Independently works on the resolution of complex claims issues, denials, and appeals.
21.    Completes projects and research as assigned.
22.    Responsible for the mentoring and training of new and end existing A/R staff as it related to registration following the training program set forth to include but not limited to policy and procedures, Epic system functionality, audits, and staff reviews Additional Responsibilities:
23.    Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
24.    Complies with policies and procedures as they relate to the job.
25.    Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure the continued functioning of equipment. Maintains work area in a clean and organized manner.
26.    Refers complex or sensitive issues to the attention of the Manager of Revenue System Operations to ensure corrective measures are taken in a timely fashion.
27.    Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
28.    Assists other staff as required in the completion of daily tasks or special projects to support the department’s efficiency.
29.    Performs similar or related duties as assigned or directed.

Minimum Qualifications:

Education:

Associate degree or equivalent experience

Licensure, Certification & Registration:

Billing Certification Preferred – Epic Resolute Professional/Hospital Billing Admin (Proficiency, Proficiency w/ Honors, or Certification)

Experience:

• 3 years of experience in registration billing and denial management environment-related field or front-end access-related field.
• Experience in training and staff development preferred.

Skills, Knowledge & Abilities:

• Strong knowledge of third-party payor reimbursement, eligibility verification process, and government and payor compliance rules.

Pay Range:

$24.15 - $32.50

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.  Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled