Revenue Cycle Specialist – Denials & Appeals

Stony Brook University • Stony Brook, NY, United States • $200k - $250k / year • 3w ago

Job Description - Revenue Cycle Specialist – Denials & Appeals (2403971)

Position Summary

At Stony Brook Medicine, the Revenue Cycle Specialist will work within the Denial and Appeals Unit of the hospital’s business office to analyze, track, and pursue Managed Care denied accounts receivable. Successful candidates will have 3 plus years’ experience in an Acute Care Hospital Revenue Cycle or Patient Accounting Department resolving denials, submitting non-clinical appeals, and collaborating with Revenue Integrity and Care Management departments to optimize Managed Care reimbursement and minimize denials.

Duties of a Revenue Cycle Specialist may include the following, but are not limited to:

Review system data and documentation to determine denial root cause and appropriate course of action.
Analyze high-balance accounts to ensure correct reimbursement according to managed care contracts including stop-loss provisions.
Identify and communicate denial trends and make recommendations for denials prevention to management.
Analyze payment and retractions to identify reimbursement deficiencies and payment retention opportunities.
Navigate insurance carrier websites for authorization, eligibility, and claim status.
Liaise with Care Management, HIMs, and Revenue Integrity departments.
Document work activity in computer systems and set appropriate follow-up.
Follow up with insurance carriers leveraging managed care contracts to ensure optimal reimbursement.
Effectively manage and prioritize portfolio to ensure timely processing and resolution of accounts.
Diligence in handling correspondence from insurance carriers. Ability to effectively communicate verbally and in written form in response to payer denials.
Effectively participate in insurance company JOC calls.
Train staff and make recommendations to improve policy and procedures for the unit as well as the office.
Special projects as assigned by management.
Proficient use of computer systems to aid in claim resolution and claim management.

Qualifications

Required:

Bachelor's degree and at least 2 years of healthcare revenue cycle experience. In lieu of a degree, at least 4 years of healthcare revenue cycle experience.
Working knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies.
Working knowledge of third party reimbursement methodology and drivers.
Working knowledge of hospital inpatient and outpatient billing requirements (UB-04, 837i).
Experience working with CPT/HCPCs and ICD-10 codes.
Proficiency with an Acute Care Hospital Contract Management system.
Proficiency in MS Office Suite, including Excel and Word.
Excellent written and verbal communication skills.

Preferred:

Bachelor's degree in Accounting/Finance, Health Information Management, Health Administration, Computer Science or related field.
Medical Coding Certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA).
Experience in revenue recovery within Cerner Contract Management and Optum Payment Integrity Compass.
Experience working with Cerner Invision Patient Accounting.

Special Notes: Resume/CV should be included with the online application.

Posting Overview: This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).

If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate is identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.

Prior to start date, the selected candidate must meet the following requirements:

Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services.
Complete electronic reference check with a minimum of three (3) professional references.
Successfully complete a 4 panel drug screen.
Meet Regulatory Requirements for pre-employment screenings.
Provide a copy of any required New York State license(s)/certificate(s).

Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.

Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status, and all other protected classes under federal or state laws.

If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.

Anticipated Pay Range: The salary range (or hiring range) for this position is $64,945 - $79,169 / year.

The above salary range represents SBUH’s good faith and reasonable estimate of the range of possible compensation at the time of posting. The specific salary offer will be based on the candidate’s validated years of comparable experience. Any efforts to inflate or misrepresent experience are grounds for disqualification from the application process or termination of employment if hired.

Your total compensation goes beyond the number in your paycheck. SBUH provides generous leave, health plans, and a state pension that add to your bottom line.