Sr. Revenue Cycle Specialist
Eye Health America
The Sr. Revenue Cycle Specialist is responsible for optimizing revenue and ensuring the accuracy and compliance of all billing and coding practices within a healthcare organization. This role involves analyzing and auditing claims, providing education and training to staff, and implementing processes to enhance revenue integrity.
Essential Functions and Responsibilities
- Review and audit claims, medical records, and documentation to identify errors, discrepancies, or compliance issues.
- Verify that services provided are correctly documented, coded, and billed according to payer and regulatory requirements.
- Work to maximize revenue by identifying opportunities for additional billable services, coding accuracy, and reducing claim denials.
- Analyze reimbursement rates and fee schedules to ensure the organization is being reimbursed appropriately.
- Provide training and education to clinical and administrative staff on coding and documentation best practices.
- Stay updated on changes in coding and billing guidelines and share this information with relevant staff.
- Monitor compliance with healthcare regulations, including CMS (Centers for Medicare & Medicaid Services) and third-party payer requirements.
- Ensure that all billing and coding practices align with regulatory standards.
- Analyze data and prepare reports on key performance indicators related to revenue integrity, such as coding accuracy, claim denial rates, and reimbursement trends.
- Identify and implement process improvements to enhance revenue integrity, streamline workflows, and reduce errors.
- Collaborate with relevant departments to resolve issues and enhance revenue cycle processes.
- Assist coders and clinical staff with complex coding scenarios and documentation requirements.
- Conduct regular chart reviews and provide feedback to improve documentation quality.
What We Offer:
- Competitive compensation and performance incentives
- Comprehensive benefits including medical, dental, vision, and 401(k)
- Career growth opportunities within a fast-growing healthcare platform
- A collaborative and mission-driven culture focused on delivering exceptional patient care
- Bachelor's degree in a related field, such as healthcare administration, health information management, or nursing. Relevant certifications (e.g., Certified Professional Coder - CPC) may be preferred.
- Several years of experience in healthcare billing, coding, or revenue cycle management, with a focus on revenue integrity.
- In-depth knowledge of ICD-10, CPT, HCPCS, and other coding systems.
- Familiarity with CMS and other regulatory billing guidelines.
- Strong analytical and problem-solving skills.
- Effective communication and training abilities.
- Proficiency in using healthcare information systems and coding software.