Provides the necessary functions to bill, collect, analyze, and adjudicate all professional and/or hospital billing and collection functions with respect to the Geisinger Health Systems. This position executes and performs programs to insure efficient operations of the Geisinger Health System Revenue Management program in order to generate sufficient cash flow to support GHS operations and strategic initiatives.
In the position of Revenue Management Specialist responsibilities include billing and collecting for all third party insurance payers adjustment functions, cash application, adjudicating, identifying, analyzing, reducing and resolving various revenue enhancement, and credit balance issues associated with professional and/or hospital accounts receivable and insuring monthly cash flow. These responsibilities further include the management of a portfolio of accounts with respect to the successful adjudication of claims on a monthly basis.
Reports to the Revenue Management Supervisor or the Revenue Management Manager.
MAJOR DUTIES AND RESPONSIBILITIES:
*1. Performs professional and/or hospital billing and collection functions within the revenue management to include, but not limited to billing and collection functions, secondary collections, cash posting, A/R resolution, adjustments, credit balance resolution, revenue enhancement and cash flow for the various clinical service lines.
*2. Performs the above-mentioned activities of the revenue management to insure cost effectiveness and organizational efficiency. Furthermore, this position executes these functions in regards to how their function inter-relates to the other revenue management functions including Patient Access, Medical Records, Hospital and Professional Billing and Collections, Cash Application, Revenue Enhancement, Human Resources, Information Systems, Financial Reporting, Process Improvement, Revenue Capture, Training, Corporate Finance, Customer Service, Practice Specialists and all of the various third party payers associated with the clinical service lines.
*3. Communicates their functional activities to their Supervisor and/or Manager, senior management of GHS as it relates to billing, insurance follow-up (collections), cash flow, cash application, revenue enhancement, organizational profitability, customer service, accounts receivable results and revenue management results.
*4. Works in conjunction with other areas within the revenue management and GHS to insure coordinated activities with respect to all revenue management needs.
*5. Participates in a minimum of sixty hours of classroom training per year.
6. Involved, when required, in the development of various revenue management and GHS strategic plans.
7. Performs other duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform.
8 Demonstrates a working knowledge and understanding of federal, state, and other third party billing requirements including HCPCS, ICD9/ICD10, HIPAA and medical terminology.
9. Develops, implements and directs various quality initiatives to insure continuous monitoring and improvements within the revenue management process of GHS. This includes performing overall departmental operating functions within pre-determined limits and within Freedom-To-Act guidelines to insure operational efficiencies and obtaining pre-determined performance and quality targets.
10. Provides analysis to supervisor and manager of trends and issues identified while performing job functions.
*Denotes essential job functions.
COMPETENCIES AND SKILLS:
Demonstrates strong presentation skills, with the ability to effectively communicate with many different audience levels.
Demonstrates familiarity with multiple computerized applications (i.e. Siemens, IDX, Tower, Contract Manager, Cadence, Epic, Electronic Medical Health Record, ePremise, NaviNet, Artiva, etc).
Demonstrates ability to meet standards set forth for both productivity and quality of work.
EDUCATION AND/OR EXPERIENCE:
Associate or Bachelors degree required.
High School diploma or equivalent required with minimum of one year relevant experience in a health care setting to include third party insurance training, credit and collection experience with a solid knowledge of insurance coverage (Managed Care, Worker's Compensation, No-Fault) required.
Requires up to 9 months on the job training to learn all aspects of the position.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
One of the nation’s most innovative health services organizations, Geisinger serves more than 1.5 million patients in Pennsylvania and New Jersey. The system includes 13 hospital campuses, a nearly 600,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. A physician-led organization, with approximately 32,000 employees and more than 1,800 employed physicians, Geisinger leverages an estimated $12.7 billion positive annual impact on the Pennsylvania and New Jersey economies. Repeatedly recognized nationally for integration, quality and service, Geisinger has a long-standing commitment to patient care, medical education, research and community service. For more information, visit geisinger.org or connect with us onFacebook, Instagram, LinkedInand Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.