Revenue Cycle Services Specialist 1

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Job Title:Revenue Cycle Services Specialist 1

Department:Health System Shared Services | Revenue Cycle Clinical Support

The Revenue Cycle Clinical Support Office (RCCS) is an area within Access and Revenue Cycle Management Shared Services responsible for managing Clinical Pre-Certification/Pre-Determinations, Retro-Authorizations, Patient Access Program vendors, Criteria review for Value Analysis, Clinical Case Reviews, Complex Billing (Medicare A to B, ASAM) Complex Denials, Clinical Appeals. RCCS is responsible for responding to Government, Commercial and Internal audits. RCCS performs denial data analytics and write-off reporting. RCCS provides extensive reporting to Senior Leadership on these areas. The Health System includes all facility billing for the University Hospital, Ross Heart Hospital, University Hospital East, The Arthur G. James Cancer Hospital, OSU Harding Hospital, Dodd Hall Rehabilitation and Ambulatory Surgery Centers. RCCS interprets payer requirements and develops processes to obtain clinical precertification and aggressive appeal arguments in collaboration with physicians. Claims are reviewed and edited to ensure accurate billing. Information Technology and Reporting are leveraged to efficiently manage the extensive volume of claim activity to ensure timely processing of claims.

RCCS is integral to the support of a successful/healthy and compliant revenue cycle. It is responsible for bringing in cash to support the financial bottom line, keeping days in Accounts Receivable low, maintaining efficient/effective operations, and supporting patient-friendly experiences.

The Revenue Cycle Specialist provides administrative and analytical support to the Director, Management team in RCCS, and nursing staff.

The Revenue Cycle Specialist position is responsible for resolving issues related to authorizations, billing, and compliance within the revenue cycle for OSU Health System through quantitative and qualitative analysis techniques. They supports OSU Health System in meeting the objectives of a successful and compliant revenue cycle by increasing cash on hand, lowering AR days, and lowering rejections/denials. This position provides support, intervention, and follow-up on a variety of processes that impact the revenue cycle including authorization review, analysis, and combining/uncombining accounts. The overall goal of the department is to ensure compliance with billing regulations yet also ensure payment.

Position Summary

The Revenue Cycle Specialist is responsible for a wide variety of functions. Daily functions revolve around analyzing and resolving issues with accounts that involve authorization, billing, and compliance. This position is responsible for independently monitoring and ensuring all in-patient accounts are billed with correct utilization review data to prevent denials. Applies payer policies and procedures to denial information.

Responsible for reviewing accounts with various claim errors that require higher-level review. This can include claims with admission or discharge date discrepancies, admission order timing issues, or various other regulatory compliance issues. Responsible for interdepartmental/intradepartmental communication and process improvement throughout the revenue cycle. Must become competent in all available systems where revenue cycle information is held.

Minimum Required Qualifications

Bachelor's degree or equivalent experience. 0 years of relevant experience required. 0-2 years of relevant experience preferred.

Additional Information

Location:Remote Location

Position Type:Regular

Scheduled Hours:40

Shift: First Shift

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

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The university is an equal opportunity employer, including veterans and disability.

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