Revenue Cycle Specialist Job Description
Revenue cycle specialist
provides ongoing revenue accounting oversight to the Department and the Finance and Accounting arm of the Medical Center and Clinics.
Revenue Cycle Specialist Duties & Responsibilities
To write an effective revenue cycle specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included revenue cycle specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
Direct engagement with sales team and clients in deal and RFP support for strategic or complex revenue cycle opportunities
Pitch, close deals
Lead strategic solutioning crossing multi-products
Execution of target client list(s)
Active involvement in Client Planning sessions with client coverage teams
Representing Voice of the Client for new product development and packaging
Sharing Competitive Intelligence with key product and sales partner
Participates in the design and development of learning experiences
Prepares and distributes training aids
Transforming current members into long term strategic relationships
Revenue Cycle Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Revenue Cycle Specialist
List any licenses or certifications required by the position: CRCR, CHC, CPC, CHAA, CHAM, AHMIA, RHIA, RHIT, CPB, CPPM
Education for Revenue Cycle Specialist
Typically a job would require a certain level of education.
Employers hiring for the revenue cycle specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Education, Business, Finance, Healthcare, Accounting, Associates, Medical, Microbiology, Pharmacy, Arts
Skills for Revenue Cycle Specialist
Desired skills for revenue cycle specialist include:
Claim submission and third party payers
Medical billing terminology
Contractual terms
Performance protocols
Applicable industry based standards
Basic accounting
Finance practices
Procedural and ICD10 coding
Accounting role
Previous experience in a finance
Desired experience for revenue cycle specialist includes:
Overseeing, educating, and motivating a team of business development and delivery experts around best-in-class approaches to sell and deliver to member executives in the Documentation terrain oversee common sales and ROI goals and metrics
Oversees and resolves issues in the various areas of the revenue cycle for providers of health care services
Maintains an efficient, accurate operation
Thorough knowledge of health care benefits and insurance regulations
Demonstrated understanding of medical insurance billing
Knowledge of Epic's Resolute Professional and/or Hospital billing modules or other large-scale clinician practice and/or hospital billing systems
Revenue Cycle Specialist Examples
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Revenue Cycle Specialist Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of revenue cycle specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for revenue cycle specialist
- Payment Postings and Reconciliations
- Research and Resolution
- Meets or Exceeds Standards for Productivity
- Responsible for identifying, analyzing and managing Process Improvement projects in the Revenue Cycle area
- The Revenue Cycle Coordinator will identify potential revenue and/or compliance issues, make recommendations to resolve and implement revenue cycle improvement initiatives and identify opportunities to improve financial outcomes
- The coordinator will also be responsible for attending key project meetings, preparing meeting minutes and action items, and conducting follow-up activities on action items
- This position will also conduct random audits to involve reviewing claims, remittance advices, and partnering with key individuals across the Revenue Cycle to produce items for projects & initiatives
- Performs other duties as required and assigned by the Billing Director
- Work the monthly and cumulative missing encounter report by validating open encounters are truly missing and working with the clinicians to ensure that they complete documentation and close encounter
- Review the closed encounters that appear on the missing encounter report to validate a charge filed in Transaction Inquiry
Qualifications for revenue cycle specialist
- Four year undergraduate degree in accounting, finance, healthcare administration, business, information technology, or engineering
- 4+ years' experience in a healthcare business setting
- Detail oriented and produce high-quality work
- Able to self-direct and remain organized
- Microsoft Word, Excel, and Access is required
- Protect confidentiality and rights of patients and health system in a diplomatic and discreet manner
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Revenue Cycle Specialist Job Description
Job Description Example
Our company is growing rapidly and is looking for a revenue cycle specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for revenue cycle specialist
- Closed visits are reviewed for possible billable services, if found then charge is manually entered through Epic – Charge Entry, if no code found, then review of scheduled appointment for validation and/or cancellation
- Supports manager/supervisor in identification of potential lost revenue related to trends in charge entry, billing, coding or contracting practices that are related to charge capture
- Under general supervision reviews the coding of diagnoses and procedure codes for inpatient acute care services to ensure correct assignment of inpatient DRGs
- Utilize standard coding guidelines and principles and coding clinics to verify that the appropriate ICD-10 codes were assigned for accurate MS-DRG or APR-DRG assignment
- Facilities all aspects of credentialing including
- Assist in compliance with the accrediting and regulatory agencies (i.e., JCAHO) in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws
- Responsible for ensuring the timeliness of credentialing/re-credentialing verification processes and tracks all application to assure turnaround time is appropriate
- Duties include the gathering, verification and evaluation of confidential healthcare provider credentials, follow-up in obtaining documentation relevant to the credentialing
- Ensures that accurate up-to-date data for each applicant is entered into the database
- Assists in managing the flow of information between the various teams and departments needed to ensure accuracy
Qualifications for revenue cycle specialist
- Degree in Finance or health related field
- Minimum 5 years experience with the development and implementation of healthcare revenue cycle management training and auditing materials and implementation programs
- 3 – 5 years in outpatient billing environment preferred
- 2 – 5 years experience working with Epic Resolute module
- Proficiency in excel spreadsheets using pivot tables, formulas and graphics
- Excellent verbal/written communication and listening skills are essential for this position
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Revenue Cycle Specialist Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of revenue cycle specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for revenue cycle specialist
- Maintains records and files as appropriate
- Interacts with employees, medical center administrative staff, physicians and office staff
- Under direct supervision reviews the coding diagnoses and CPT codes for multi-specialty coding or SDS coding are assigned correctly and if all diagnoses and procedures are identified
- Under general supervision reviews the coding diagnoses and E/M levels verifying the proper codes were assigned
- May create and present education and interact with client and providers
- Develop and deliver educational training materials to revenue center employees
- Focus on standardization across revenue centers
- Works closely with the policy & procedure standardization team to support education efforts for revenue cycle employees through the development of presentations and communications
- Perform quality assurance checks to ensure procedures are adhered to
- Maintains training strategy and plan
Qualifications for revenue cycle specialist
- Interpersonal skills necessary to represent organization in a professional and positive manner
- Ability to effectively organize and prioritize tasks in order to complete assignments and meet deadlines
- Clinical liaison/expert to PFS financial clearance and third party payers
- Ability to clearly communicate clinical treatments and rationale for treatment to payer staff
- Use internal and external resources to obtain and provide clinical information to payers
- Establish sound working relationship with payer pre-service review/precertification staff to obtain prior authorizations for surgical procedures/medical admissions
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Revenue Cycle Specialist Job Description
Job Description Example
Our innovative and growing company is looking for a revenue cycle specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for revenue cycle specialist
- Manages open invoices
- Prepares monthly A/R reports, reviews open invoices for resolution, meets with providers to show account status
- Manages patients with past due balances
- Ensures that billing is done correctly
- Assists with strategic planning to decrease denials and increase collections
- Works with Non-Par Providers to manage payment negotiation agreements for managed care plans
- Produces and manages billing reports related to charges, payments, denials, Interprets data, and develops improvements
- Audits Post-Op visits routinely to ensure that visits are billed within the global period and visa versa
- Assists in educating staff as required on billing issues and changes
- Ability to perform all essential responsibilities of the Customer Care Associate position and perform them as directed
Qualifications for revenue cycle specialist
- Collaborate with PFS leadership to formulate action plans for payer precertification denial management
- Interact with peers in other finance related departments to communicate potential and actual prior authorization denials (Utilization Management Specialists/Supervisors/Directors
- Ability to complete clinical aspects of specific payer forms and facilitate medical director’s completion of forms
- Ability to call payers to initiate precertification and provide clinical information for Hopkins Access Line (HAL) patients
- Licensed in the State of Maryland as a Registered Nurse (RN)
- Requires three to five years clinical experience as staff nurse with broad range of clinical experience
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Revenue Cycle Specialist Job Description
Job Description Example
Our growing company is looking to fill the role of revenue cycle specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for revenue cycle specialist
- Stays current with relevant guidelines and policies for medical devices (e.g., HIPAA, Medical Device Reporting)
- Ensures compliance with all Company quality procedures and guidelines including but not limited to Quality Policy and Code of Business Conduct and Ethics
- Meets standards for production and accuracy within 3 months in shift date
- Performs all job duties according to Contact Center policies and procedures
- Routinely reviews regulatory and third party payer changes impacting revenue cycle operations
- Performs new hire and remedial training on processes and policy and procedures
- Performs quality assurance audits within the revenue cycle departments
- Coordinates with operational areas ensuring policies and procedures are maintained to support revenue cycle areas
- Coordinates the revenue cycle operational needs for new programs and sites to ensure effective capture of patient registration information and billing requirements
- Develops and maintains education materials related to revenue cycle departments in coordination with Information Technology Epic team analysts
Qualifications for revenue cycle specialist
- Analyze and trend payer authorization and denial practices
- Experience in utilization management or in payer environment preferred
- A minimum of two (2) years billing experience
- Must be able to operate a computer and demonstrate Windows navigation skills
- One (1) year collections and/or call center experience (Preferred)
- 4-7 years experience in a clinical environment (acute or ambulatory), required