Revenue Cycle Specialist

About This Role

The Revenue Cycle Specialist is a versatile professional responsible for resolving all patient claims and ensuring accurate demographic and insurance information. This role involves collecting and following up on accounts, communicating financial policies, and advocating for patients throughout the account cycle. The specialist also supports leadership in quality improvement and assists in training new staff.

Responsibilities

• Resolve all patient claims
• Update demographic and insurance information for accuracy on all patients
• Collect and follow up on all assigned accounts prior to, during, or after admission and discharge
• Communicate Emory Healthcare's financial policies to all patients
• Identify patients who require financial counseling intervention
• Provide information regarding resources for patients who need financial help after discharge and/or during collections and follow-up activities
• Verify, research, and complete all paperwork and forms to bill all types of claims for reimbursement
• Serve as a patient advocate during the cycle of the account
• Assist with departmental workflow as needed
• Identify and notify leadership of issues and initiate appropriate action for resolution
• Serve as point person for employee questions
• Maintain thorough understanding of insurance, payment reimbursement, account reconciliation, referrals, authorizations, and account follow-up to secure reimbursement of claims
• Provide support to leadership facilitating quality improvement by reporting problems, concerns, and opportunities for increased revenue and decreased denials through the quality assurance process
• Assist in training and development of new staff members
• Review and operationalize contracts as they relate to billing and reimbursement of complex claims
• Understand and maintain knowledge of standards for care of specific transplant population and the phases of donors and recipients (may be required)
• Provide liaison and educational services in support of standards
• Identify and resolve financial issues relating to all patients
• Work closely with Management in formulating and implementing departmental objectives toward enhancing the workflow of the department
• Attend education sessions and insurance payor forums as appropriate
• Review, analyze, and understand Managed Care Contracts and various aspects of patient care to maximize reimbursement, including but not limited to transplants, hospice, infusions, rehab, and Center of Excellence patients
• Maintain knowledge of payer requirements including pre-cert requirements, splitting of claims, analyzing payments, and researching complex payment variances