Revenue Cycle Specialist

Research denials or audits from all commercial and governmental payors. Performs payor compliancereview on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains predeterminations, prior authorizations, and retro authorizations when required bypayor. Responds to all account reviews with the best possible efforts to ensure reimbursement, recoveroutstanding revenue, and prevent future revenue loss while meeting all appropriate payor or governmenttimelines. Recovery efforts include but are not limited to written letter, email, web site, and telephoniccommunication.

Minimum Education, Experience, Training and Licensures Required

• Bachelor's degree with two years healthcare experience

• In lieu of bachelor's degree, five years of healthcare experience including two years in a revenue cycle related area such as registration, patient financial services, or managed care

• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization/notification, medical necessity, and timely filing guidelines); payor denial appeal/payment variance resolution processes; and managed care contracts. Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.

• CPC certification and/or coding experience preferred.