Revenue Specialist III, ROPS

We are seeking a revenue operations specialist to work closely with practices and leaders to investigate and design strategic initiatives in order to improve revenue cycle statistics, reporting capabilities, and overall performance. This position will also be responsible for implementing, designing, and providing support for business and administrative analytics within revenue cycle functional areas; develops reports with key performance indicators, metrics, data points, and formulas to support management objectives; determines how processes can be aligned with best practices to achieve optimal results, measurable change, and a quantifiable, positive contribution.

The revenue operation specialist must have the ability to define problems collects data, establish facts, and draw valid conclusions. They must in addition have the ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete.

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.

• Highly organized

• Initiative to work independently

• Familiarity with AWP pricing rules

• Pharmacy and Major Medical healthcare billing

• Proficient with telephone and email communications

Responsibilities:

• Assist in preparation of estimating net revenues

• Analyze FFS (fee-for-service) collection trending

• Work in a consultative capacity to identify and implement process, technology and training initiatives to support the accurate and timely billing and collection of accounts receivable.

• Provide analytical support to and develop tools for company operations to enhance their skills in detecting both current and future performance issues

• Perform research on best practices and standards in the revenue cycle for the healthcare industry to assist in standardization of goal setting performance monitoring

• Develop and manipulate large data sets as well as analyzes data groups to assist in the development and implementation of process improvement strategies

• Understanding knowledge of 837/EDI process including payer specific rules.

• Assists in auditing all electronic reports and paper claims and make corrections when necessary.

• Ensures accessibility and flow of performance information to all relevant parties; works to prevent or address data transmission issues

• Analyzes financial and revenue cycle performance data to identify trends, patterns, and root causes

• Seven years of relevant healthcare claims experience with identifying insurance underpayments and revenue recovery.

• Highly analytical with excellent reconciliation experience and sound accounting working knowledge

• Must be familiar with commercial and government healthcare reimbursement methodologies.

• Strong knowledge of hospital billing and managed care.

• Must have strong technical skills, advanced Excel.

• Excellent verbal and written communication skills.