Revenue Cycle Services Specialist 1

Revenue Cycle Services Specialist 1

The Ohio State University Health System is committed to improving access and service to customers. The Revenue Cycle Specialist functions as an integral member of the health care team to reflect a culture of cooperation, enthusiasm, and mutual respect. This position will provide follow-up to denials and help resolve ongoing billing and payor issues. The Revenue Cycle Specialist position is responsible for resolving issues related to authorizations, utilization review requirements, billing, and compliance within the revenue cycle for OSU Health System through using quantitative and qualitative analysis techniques. They support the OSU Health System in meeting objectives of a successful and compliant revenue cycle through 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.

Position Summary:

The Revenue Cycle Specialist is responsible for a wide variety of functions that primarily revolve around analyzing and resolving issues with accounts that involve authorization, billing, and compliance. This position serves as an expert in understanding the payers' requirements and works with various other departments to identify issues and resolve them prior to billing or after a denial is received. This position is responsible for independently providing a higher-level review of all medical necessity and authorization denials to determine a root cause for the denials. This position analyzes data to identify historic trends, perform comparisons against identified standards, and assists in formulating strategic plans for appealing denials.

This position uses expert knowledge of payer authorization requirements to write and submit appeals for administrative authorization denials. Identifies and develops appropriate tools to track issues, analyzes workflows, identifies logistical and operational issues to target for improvement. Further, this position is responsible for reviewing accounts with various claim errors that require a second higher-level review. This can include claims with admission or discharge date discrepancies, admission order timing issues, or various other regulatory compliance issues.

This position is also responsible for interdepartmental/intradepartmental communication and process improvement throughout the revenue cycle. This position must become competent in all available systems where revenue cycle information is held, including Midas and EPIC modules for Cadence, ADT, Ambulatory, and Resolute.

Minimum Required Qualifications:

For Hire: Bachelor's Degree in Business or Health Care Administration OR equivalent combination of education and experience. Master's Degree in Business or Operational Efficiency highly desired. 2-3 years of operational experience within the Revenue Cycle. Familiarity with the DMAIC process and lean tools and concepts. Lean/Six Sigma certification and/or experience highly desired. Must possess excellent analytical skills, good written and oral communication skills. Must possess knowledge of process mapping/value stream mapping tools. Proficient with computer information systems, preferably Epic, and Microsoft Word, Excel, and PowerPoint.

Location:

East Hospital - Main (0398)

Position Type:

Regular

Scheduled Hours:

40

Shift:

First Shift