Senior Revenue Cycle Specialist

ABOUT THE ROLE
The Senior Revenue Cycle Specialist heavily interfaces directly with IVX Health administrative and clinical staff, payer representatives, referring providers, and patients daily to review delivered services and to ensure complete and accurate information is documented. This role is primarily responsible for managing the full lifecycle of the revenue cycle as required by all payers. The Senior Revenue Cycle Specialist is a customer service role meant to serve as a resource to those stakeholders who are directly involved in patient care. The ability to multitask in multiple business office/practice management systems and offer exceptional customer service is the foundation of this role.

This position is considered fully remote, offering a great work/life balance. A typical schedule is Monday - Friday, during regular business hours. No weekends required!

ESSENTIAL JOB FUNCTIONS

• Engage daily with market leaders to obtain assistance with denials that require local assistance.
• Review and answer escalated emails from all IVX markets
• Facilitate review and submission of escalated appeals from Billing Manager or Follow-Up Team as needed
• Support Billing Managers by training new colleagues on follow-up processes to ensure proficiency in all required functions
• Review and obtain any additional clinical information (including but not limited to medical history, support for diagnosis, and letters of medical necessity) required to complete payer appeals
• Diligently review underpayment reports and collaborate with Billing team members to resolve
• Lead overpayment report review and refund submission to Accounting
• Communicate with insurance companies to resolve denials and obtain payment
• Work with Billing Manager to establish follow-up in new markets prior to handing over to assigned follow-up team member
• Facilitate collaboration calls with Prior Authorization, Contracting and Credentialing teams as needed to identify trends and resolve denials
• Investigate outstanding unpaid claims reports to include making sure new payers are set up for RTE, ERA and EFT with clearinghouse
• Assist with any denied claims needing Prior Authorization team intervention
• Assist with payer policy review for team members working on denials
• Assist Billing Manager with QA of payment posting, insurance/patient follow-up, coding, and financial counseling teams
• Demonstrate excellent customer service skills through patient-centered communications
• Contribute to departmental continuous improvement by recommending process improvements
• Take ownership of special projects, research data and follow through with detailed action plans as assigned by your manager
• Actively participate in problem identification and coordinates resolution between appropriate parties
• Perform duties and job functions in accordance with the policies and procedures established for the department.

ESSENTIAL SKILLS AND COMPETENCIES

• Proficiency with standard office software applications (Microsoft Office, Outlook, Teams, etc.)
• Excellent organizational, consultative, analytical, and problem-solving skills
• Ability to work independently under general supervision and effectively prioritize workload
• Ability to multitask and adapt to fast-paced work environment
• Takes initiative and capitalizes on all opportunities to improve department efficiency and effectiveness
• Strong interpersonal skills and ability to adjust communication style to match audience. Ability to collaborate and communicate at all levels of an organization
• Knowledge of basic medical terminology

REQUIRED EDUCATION AND EXPERIENCE

• High School Diploma or GED required
• 2 Year / Associates Degree in Medical Office Managing, Medical Insurance, or Medical Coding strongly preferred
• 5-7 years’ experience working in full revenue cycle in a facility or physician office setting or similar role
• Certified Professional Coder or Certified Professional Biller is a plus