Revenue Cycle Specialist
- High school or GED - 5 years related experience Mary Washington HealthcareJob Description Job Title: Revenue Cycle SpecialistStatus: In ReviewDate Approved: Revised August 2015, December 2014Exemption Status: Exempt Job Summary: This position collaborates with the MWHC employed physician group in optimizing the performance of its professional fee revenue cycle to ensure maximization of revenue and cash flow while maintaining the highest levels of patient, physician, employee and other customer relations. Specific areas of responsibility for the incumbent of this position include registration, charge capture and initial submission, point of service collection, and review and address of vendor and payer billing or denial task lists. This position also includes the oversight of all front-end business related functions impacting billing and collections throughout the employed physician practice and ensuring all managers and Associates impacting the revenue cycle are appropriately trained on and compliant with established policies and procedures. Specific areas of responsibility include registration, charge capture, point of service collections and file maintenance. This position is responsible for establishing and maintaining productive relationships with key stakeholders, including physicians, managers, staff and the external billing office. Essential Functions & Responsibilities: Analyzes training needs through the use of surveys and side by side evaluation to develop and implement new training programs or modify and improve existing programs. Collaborates with Practice Managers and other leaders in the development of workflows to create and improve processes related to revenue cycle and other operational functions as needed. Analyzes Associate work performance by utilizing the appropriate Allscripts and Payerpath reports along with monthly practice dashboard reports and providing Quality Assurance feedback to the appropriate managers and directors as needed. Reviews policies and procedures related to front-end revenue cycle processes. Modifies as needed to ensure best practice. Develops new policies and procedures as required.Monitors compliance of individual practices with established policies and procedures utilizing reports available through the existing Practice Management and Electronic Health Record systems as well as data provided by the external billing office. Quickly and proactively responds to revenue cycle issues to promote maximized reimbursement.Thoroughly understands and utilizes the Practice Management (PM) and Electronic Health Record (EHR) systems' reporting and operating capabilities. Identifies and implements methods to automate and streamline revenue cycle processes through use of the PMS and EHR.Routinely monitors timeliness of charge capture to identify and address any delays and ensure gross revenue maximization at the end of each month.Coordinates the exchange of information between the co-source vendor, medical practices, Health Information Management Department and other departments to obtain and analyze additional patient information to document and process billing; responds to insurance inquiries and manage liability accounts. Promotes effective communications between Information Services, co-source billing vendor and front-end staff to ensure ongoing education, training and timely problem resolution.Develops and provides training to office staff as required in order to be proficient and compliant with established policies and procedures.Works closely with managers of physician practices to ensure understanding of and compliance with established policies and procedures. Develops work standards, monitors the quality and quantity of processed work, and ensures that policies are communicated and administered consistently. Works closely with site personnel and operations managers to monitor ongoing compliance to policies and procedures relating to the revenue cycle.Promotes exceptional customer service and maintains compliance with all relevant policies and procedures.Participates in appropriate meetings as needed. Provides feedback to Practice Managers and other leaders on Associate participation and Associate training and development outcomes utilizing evaluation procedures. Serves as the Project Manager for the onboarding of all new practice acquisitions; works with all MWHC departments with a role in the successful integration of newly acquired practices to ensure timeline for deliverables is met. Performs other duties as assigned. Qualifications: High school diploma or equivalent required. Associates Degree preferred. Minimum of 5 years of experience in revenue cycle operations and/or physician practice management. Minimum 3 years of experience managing or directing patient registration, time of service collections and charge entry functions in a multi-specialty setting. The ideal candidate demonstrates extensive knowledge of third-party and insurance company operating procedures, regulations and billing requirements, and government reimbursement programs. .