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Emory Healthcare/Emory University Revenue Cycle Specialist II in Atlanta, Georgia

Overview

Work Hours: Full-time 8a-4:30p

Candidate must have experience

  • Precerting chemotherapy infusion treatments

  • Oncology knowledge

  • Experience reviewing clinical documentation/medical records

  • Familiar with HCPC and diagnosis codes

Description

JOB DESCRIPTION:

  • Versatile in all aspects of the Revenue Cycle through Final Claims Resolution.

  • This position updates demographic and insurance information for accuracy on all patients.

  • Collects and follows up on all accounts assigned prior to, during or after admission and discharge.

  • Communicates hospital's findings back to the Physician, Nursing Team and Patient as appropriate.

  • Identifies patients who require financial counseling intervention; provides information regarding resources for patients who need financial help after discharge and/or during collections and follow up activities.

  • Verifies, researches and completes all paperwork and forms to bill all types of claims for reimbursement.

  • This may include insurance company, drug replacement, and/or Pharmaceutical programs to help patients with their out of pocket expenses for drugs.

  • Serves as a patient advocate during the cycle of the account.

  • Assist with departmental workflow as needed.

  • Identifies and notifies leadership of issues and initiates appropriate action for resolution.

  • Communicates and provides feedback as needed to section leaders, hospitals CFO, Managed Care, Finance and other leaders.

  • Maintains thorough understanding of insurance, payment reimbursement, account reconciliation, referrals, authorizations, and account follow-up to secure reimbursement of claims.

  • Provides support to leadership facilitating quality improvement by reporting problems, concerns, and opportunities for increased revenue and decreased denials.

  • Assists in training and development of new staff members.

  • Must be able to review and operationalize contracts as it relates to billing and reimbursement of claims, including infusion, transplant and other complex accounts.

  • The position may be responsible for understanding and maintaining knowledge of standard for care of specific transplant population and the phases of donors and recipients.

  • This position is responsible for assuring these are followed and completed for compliance and reimbursement.

  • Provides liaison and educational services in support of standards.

  • Identifies and resolves financial issues relating to all patients.

  • Problem solving skills are required as the applicant must be able to use various tools, analyze the situation, research data and resolve and/or formulate a decision.

  • Works closely with Management in formulating and implementing departmental objectives toward enhancing the work flow of the department.

  • This position requires heavy phone and computer usage, and a detailed knowledge of applicable EMRs, patient accounts, payer, and financial tools.

  • Additionally, education sessions and insurance payor forums should be attended as appropriate.

  • Position can serve as a trainer on providing education to others.

  • Specialist may set up internal and external meetings with staff and payor representatives on a quarterly or as needed basis to discuss concerns relative to billing and proper reimbursement.

  • Specialist will assist in keeping documentation current with payor updates and trends as they occur.

  • Specialist is required to review, analyze and understand the Managed Care Contracts and various aspects of patient care to maximize reimbursement.

  • The Revenue Cycle Specialist must be able to work independently.

  • They must have excellent verbal, written, analytical and interpersonal communication skills.

  • Professionalism must be maintained at all times regardless of circumstances.

  • Organizational skills are also very important.

  • Performs other duties as assigned, pertinent to the Revenue Cycle.

MINIMUM QUALIFICATONS:

  • Bachelors Degree with three years of revenue cycle experience; OR any combination of equivalent education and healthcare experience.

  • Certified Patient Accounts Representative (CPAR) and/or Certified Patient Financial Counselor (CFC) required.

PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

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Division Emory Healthcare Inc.

Campus Location Atlanta, GA, 30308

Campus Location US-GA-Atlanta

Department EHI Infusion Precert

Job Type Regular Full-Time

Job Number 80021

Job Category Revenue Cycle & Managed Care

Schedule 8a-4:30p

Standard Hours 40 Hours

Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.

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