Claims Resolution Specialist II Hybrid
Solaris Health (UroPartners and Urologic Specialists of Northwest Indiana ) - Westchester, IL
Apply NowJob Description
Description:GENERAL SUMMARYMinimum 90 days training in office with potential for hybrid depending on performance!The Claims Resolution Specialist is responsible for monitoring the charge capture process and identifying issues and process improvement opportunities within the Mid-Revenue Cycle. The position is responsible for revenue leakage root cause analysis and resolution recommendations. This role supports the revenue cycle workflows, charge capture, and work queue processes. This position will help optimize Revenue Cycle by evaluating, validating, and trending data for presentation to all levels of the organization. This role reports to the Coding Supervisor.ESSENTIAL JOB FUNCTION/COMPETENCIESMonitors scheduling and revenue reports for all practice locations to ensure all charges are entered timely and appropriately according to charge capture policy standardsMonitors practice adherence to charge reconciliation processesWorks Missing Encounter Report to identify missing charges and ensure they are posted timely and accurately ? Runs surgery schedule weekly and monthly to ensure all scheduled surgeries and related charges have been billedMonitors late charges and write-offs by reviewing reports weekly to determine root causes for late chargesMaintains charge screens and department charge master files ? Provides feedback to Coding & Revenue Integrity Manager on consistent basis for those providers/clinicians/practices that are not meeting charge entry standardPerforms quantitative and financial analysis from daily audit findings as it pertains to charge captureProvides estimated revenue impact from audit findings to leadershipWorks with Revenue Integrity Team, Clinical Operations and RCM (Revenue Cycle Management) staff to implement corrective actions to ensure compliant charges, prevent future rejections/denials and accurate and reimbursementResponds to queries regarding chargesParticipates in ongoing coordination and resolution of revenue issues as they arise.Assists in troubleshooting and resolving issues related to the patient mid-revenue cycle and assists in development and recommendations Job may require other duties as assignedCERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTSCoding and/or Physician Billing Certification, preferredKNOWLEDGE | SKILLS | ABILITIESDemonstrates understanding of business and how actions contribute to company performanceDemonstrates excellent customer service skillsKnowledge of medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD) coding, and the entire revenue cycle processKnowledge of EHR (Electronic Health Record) software systems and Microsoft Office productsProfessional verbal and written communication skillsAbility to develop reports and create presentationsAbility to work collaboratively across disciplines and business linesMust be comfortable educating staff membersAbility to handle multiple tasks with excellent problem-solving skillsStrong analytical skills with ability to make conclusions and recommendationsWell organized with the ability to maintain accuracy and confidentialityRequirements:EDUCATION REQUIREMENTSHigh school diploma or general education degree (GED); or equivalent combination of education and experience.EXPERIENCE REQUIREMENTSMinimum of three years' revenue cycle experience within a physician practiceExperience in Urology or physician practice environment preferred
Created: 2024-10-04