Revenue Cycle Specialist - Regular F/T

Job Title: Revenue Cycle Specialist, 

Department: Administration

Reports To: 

Salary Level: Est. 48K Low (KGS 9), 65K Median (KGS 10/11), 90K Upper (KGS 12}

FLSA Status: Exempt

 Approved By: October 2019

 Approved Date:

GOALS FOR THE POSITION: (1) To provide oversight and improve the revenue cycle process from beginning to end (front desk, medical documentation, coding, claims, reporting etc.) for all pertinent KMC departments (clinic, behavioral health, dental, pharmacy, ambulance, diabetes, transportation, etc.); (2) To facilitate systems and policy improvements and expand billing opportunities; and, (3) To remain informed of current and pending billing policies and integrate appropriate changes as needed to improve KMC revenue.

SUMMARY: The Revenue Cycle Specialist oversees revenue cycle management activities for our organization's billable clinical activities. This position requires in-depth knowledge of billing, invoicing, arranging payment methods, overseeing collections, accounts receivable, and proper financial statements. The Revenue Cycle Specialist is a key role within our organization, working across multiple departments, and helps drive the medical center's 'success, retention and patient care.

FUNCTIONS & RESPONSIBILITIES: The Revenue Cycle Specialist will support and assist in all departments and aspects of Revenue Cycle Management. This position is responsible for supporting management in maintaining, improving, processing, and evaluating the revenue cycle process from referral through invoicing for K'ima:w Medical Center. This will encompass cross-training and daily contribution across multiple departments driving the Revenue Cycle process including, but not limited to Patient Benefits, Medical, Dental, Behavioral Health, Medical Records, PRC and Billing.

As Revenue Cycle Specialist for K'ima:w Medical, you focus on partnering with our billable service departments to clearly understand their goals, challenges, organizational structure and key business drivers. The role of the Revenue Cycle Specialist oversees the team's daily data-entry activities and enhances overall performance and daily management. The Revenue Cycle Specialist serves as a liaison between departments and must be flexible to address the current needs of the

organization. Significant activities include, but are not limited to the following:

1. Monitors overall medical billing operations, including:
   1. Ensuring effective flow of demographic charge and payment information
   2. Ensuring accurate claim submission and performing account reconciliations
   3. Oversees aggressive follow-ups with accounts receivables (A/R), including preparation of denial appeals and distribution of patient statements
   4. Track fee schedules and insurance denials in order to ensure fully allowed reimbursement
2. Identifies and implements strategies to improve internal and medical center processes.

3. Incorporates and executes quality assurance processes related to ensure accurate clinic billing activity.
4. Reviews and analyzes patient accounts, identifies trends and issues, and recommends solutions.
5. Collaborates with other team members to improve overall team environment.
6. Provides a high level of customer service to both KMC and patients by identifying and efficiently resolving insurance and other billing-related issues.
7. Remains informed of current and pending policies associated with billing and the clinic's overall financial health.
8. Assists in setting benchmarks and tracking of performance indicators as related to the revenue cycle.
9. Explores opportunities for expansion of current billing schemes and may be delegated as an advocate for KMC in leadership forums.
10. Trains current and new staff as needed to improve KMC revenue.
11. Perform other duties as assigned.

A certified revenue cycle professional works in a mid-management position within the financial healthcare system. Responsibilities involve accurately monitoring patient registration, completing billing procedures, following credit and collection protocols, and managing revenue cycles.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each primary responsibility satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or competencies required. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary responsibilities.

PROFESSIONALISM: Shows pride in personal appearance and grooming; displays a positive attitude about work; respects the confidentiality of clients; and is congenial with public and peers.

OTHER SKILLS AND ABILITIES:

• Knowledge of Resource and Patient Management System and Electronic Health Records (Indian Health Service) preferred.
• Ability to teach and train in both one-on-one and group settings.
• Ability to work with persons of different skill-sets, and backgrounds, helping them achieve their maximum potential.
• Ability to master in-house computer and software required.
• Active knowledge of clinical terminology preferred.
• Analytical ability to evaluate and interpret clinical data.
• Clerical ability to operate a variety of office machines and competent keyboarding skill.
• Knowledge of filing regulations, guidelines and office procedures.
• Ability to work independently under established priorities and deadlines.
• Knowledge of maintaining and managing files and records.
• Knowledge of grammar, spelling, punctuation, and common technology.
• Competent level of Windows based skill.
• Knowledge of Microsoft Excel and Word.
• Sound judgment, tact, and confidentiality for all related work required.
• Must have excellent communication skills with the ability to talk to people in crisis situations.
• Must be able to identify and maintain confidential information.
• Must sign a confidentiality statement.
• Must be able to type at least 45 words per minute.
• Must be punctual and willing to work additional hours if necessary.
• Must be able to perform all job duties in stressful situations.

EDUCATION and/or EXPERIENCE:

• Bachelor's degree (B.A.) from four-year college or university, OR equivalent proven work experience is required. Extensive experience in health care administration.
• Knowledge of medical billing, front-office, physician practice management and healthcare business processes.
• Strong understanding of medical billing/coding, with understanding of various insurance carriers, including Medicare, private HMOs, and PPOs.
• Exceptional written, verbal and interpersonal communication skills required.
• Professional demeanor required.

CERTIFICATES, LICENSES, REGISTRATIONS:

• Current CPR certificate or have the ability to obtain one within 60 days of hire.
• CRCS certification: A Certified Revenue Cycle Specialist (CRCS) is a health care finance professional who obtained exclusive credentials through the American Association of Health Care Administrative Management (AAHAM).

CONFIDENTIALITY: Employees must be aware of and adhere to K'ima:w Medical Center's Confidentiality Policy and deals appropriately with patient confidentiality at all times.

CONDITIONS OF EMPLOYMENT: Employee is subject to base line and random drug testing per the Hoopa Tribal Drug & Alcohol Fit for Duty Policy. Employee will serve a 90-day introductory period. Employee is subject to introductory and annual performance evaluations. Preference will be given to qualified Indian applicants pursuant to the Tribe's TERO Ordinance.

ANNUAL TRAINING REQUIREMENTS: At a minimum Employee is required to be certified for the following training 1) Health Stream courses and 2) CPR.