To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to review and audit recorded work effort on claims and phone calls to review items such as inaccurate payment postings, contractual adjustments, reclassification of accounts, denied claims, debits, credits and appeals.

• Will review critical business processes, primarily Billing, Collections, Dispute and Denial Management, Credits, Pre-Legal and Revenue Analytics for government and non-government operations.

• Ability to work independently to meet objectives in a repetitive auditing environment.

• Possesses an exceptional eye for detail and process improvement.

• Ability to identify problems, gather and analyze information skillfully and provide recommendations for process improvements.

• Independent, logical thinker with ability to perform detailed data analysis

• Demonstrated ability to build strong working relationships with key internal and external stakeholders (Centralized Operations, Compliance, Facilities) and be a thought leader/influencer for change.

• Advanced troubleshooting abilities, with ability to problem solve complex technical issues
• Must demonstrate excellent professional communication skills through clearly written, concise and comprehensive documentation; strong technical writing skills
• Must be capable of executing and publishing written requirements utilizing the business intent and goals, while providing technical details to support workflow or system development
• Ability to develop and/or present training to operations trainers and/or business users
• Intermediate level skills in applications such as Microsoft Excel, Word, and Visio
• Additional skills preferred, not required:
• Knowledge of healthcare revenue cycle
• Knowledge/experience with system design in a database environment
• Knowledge of project management methodologies
• Knowledge of research methodology, principles and procedures

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• BA/BS Preferred or 3-5 years equivalent experience in Healthcare Revenue Cycle
• 3-5 years of Supervisory or Management experience in healthcare billing, cash collections, cash application, or denial management.

• Extensive knowledge on critical business processes, primarily Billing, Collections, Dispute and Denial Management for different line of businesses (Medicare, Medicaid, Managed Care, etc.).

• Medical billing and claims experience with an understanding of healthcare reimbursement process.

• Working knowledge of critical systems such as ACE, VI Web, On Demand, PBAR, MedAssets, Epremis and workflow.

• Strong computer skills, and intermediate skill level in Microsoft Office applications (Word and Excel) is required.

• Medical billing and claims experience with an understanding of healthcare reimbursement processes.

• Working knowledge of Electronic billing, Hardcopy billing, UB-04s, ICD-9 codes, and CPT codes.

• Trained in HIPAA guidelines.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone.

• Includes ability to type, sit for long periods of time, view claims on a computer, and listen to phone calls through headphones.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office work environment
• Moderate office noise

• Ability to travel 5% of time