Healthcare Revenue Cycle Specialist

posted on February 4, 2019

Job Description

Location: San Francisco, CA

Type: Permanent

Job Function Summary:

  • Involves revenue cycle functions for the healthcare enterprise, including system billing, reporting and support.
  • Ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services.
  • Impacts processes to include charge capture, coding, insurance identification, data entry, billing, payment posting, refund processing and collections.
  • May also be responsible for / integrated with business office operations.

Generic Scope:

  • Experienced professional who knows how to apply theory and put it into practice with in-depth understanding of the professional field; independently performs the full range of responsibilities within the function; possesses broad job knowledge; analyzes problems / issues of diverse scope and determines solutions.

Custom Scope:

  • The Service Line Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture/charge description master processes.
  • This position also has a broad understanding of all areas of the revenue cycle; including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services.
  • This position will lead, support, and coordinate on-going charge capture improvement initiatives for assigned service line areas; including charge reconciliation activities, new service implementation, and identification of revenue management opportunities.
  • The Service Line Specialist will coordinate all Revenue Integrity activities on behalf of assigned service line areas; department charge capture education, charge audit activities, charge description master management, and monitoring of charge capture related metrics.

Department Overview:

  • Revenue Management Department has responsibility for patient chargeable services, supplies and pharmacy items including charge description master (CDM) and fee schedule set up and maintenance, CPT/HCPCS and revenue code assignment, pricing, charge capture and revenue reconciliation activities, and acts as a liaison between Finance and operational leaders.

Key Responsibilities:

  • Liaisons with departments to thoroughly define reporting and information requirements.
  • Identifies data source, develops and delivers routing and adhoc reports and presentations.
  • Acts as the charge capture subject matter expert and initial contact to assigned clinical areas.
  • Evaluate revenue cycle inquiries and propose improvements or enhancements to system to maximize revenue.
  • Conducts and evaluates annual charge capture reviews and workflows to ensure consistent principles with coding, nomenclature and pricing for assigned cost center and/or new department creation.
  • Collaborates with departments to design new workflows and conducts charge validation in order to maximize revenue.
  • Regularly reviews and updates charge capture related policies and procedures for assigned clinical areas.
  • Provides timely educational intervention in support of charge capture processes.
  • Develops training materials for clinical area use and reference.
  • Conducts and leads regularly scheduled, on-site meetings with assigned service line clinical departments to ensure accurate and charge capture practices and workflows are in place; including daily charge reconciliation.
  • Revenue / WQ Monitoring and Oversight
  • Monitors gross revenue metrics against established benchmarks for assigned cost centers; assist clinical department to identify revenue variance root-causes and mitigation of discovered issues and communicates to Service Line Special Lead and Revenue Integrity Manager.
  • Applies dashboard and other processes for continuous analysis of complex revenue cycle functions of diverse scope.
  • Audit data input for validity and accuracy.
  • Work proactively with departments across the system to assure appropriate revenue cycle practices and compliance with internal and external regulations.
  • Performs daily review and monitors clinical department workqueues (APeX Charge Review, Account, and Charge Router Review workqueues, etc) and provide assistance to department representatives to resolve issues, as needed.
  • Actively resolved edits routing to Revenue Management owned work queues, performed ongoing trending and root-cause analysis.
  • Independently generate reports and analyze complex financial data.
  • Identifies trends in revenue cycle operations and presents reports to all levels of hospital management and physician leaders.
  • This includes, but not limited to, MyReports, Cognos, RevDash, Performance Portal, etc.
  • Collaborates with the Revenue Integrity CDM Manager to support ongoing CDM updates, preference list maintenance, or charge interface charging mechanisms.
  • Coordinates system related upgrades or application updates between assigned clinical areas and Information Technology department.
  • Collaborates with Advisory & Audit Services, Compliance, other internal/external auditor(s) to review results from retrospective and concurrent audits, develop an action plan to resolve discovered issues, and ensure implementation.
  • Engages Patient Financial Services (PFS), Health Information Management (HIM), and other departments to determine denials and work queue edits and mitigation plans.
  • Monitors and completes assigned APeX ServiceNow tickets.
  • Ensures tickets are completed to the satisfaction of the end user.
  • Reviews Medicare intermediary and third-party payer bulletins, memos and websites to keep current on coding requirements, pending changes, and communicate relevant information to all applicable departments.
  • Performs other duties as assigned and appropriate to the position.

Knowledge, Skills and Abilities:

  • Four (4) to six (6) years of experience in clinical charge capture, charge description master, coding, government/third-party reimbursement, or similar healthcare experience
  • Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle, specifically revenue integrity, and its component operations, including billing, coding, collections, charge capture, contractual adjustments, third-party reimbursements and compliance.
  • Experience in managing and/or developing charge description master or charge capture processes, policies, and/or procedures.
  • Knowledgeable in use and application of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Revenue codes.
  • Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle.
  • Detail-oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities and effectively address complex, urgent issues as they arise.
  • Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management.
  • Skills in common database, spreadsheet and presentation software.
  • Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner.
  • Ability to prepare compelling and informative reports and presentations.
  • Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions.
  • Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.
  • Proven ability to work with managers, serving as a technical resource, providing recommendations and advice on complex regulatory changes, and industry trends and developments in revenue cycle management.
  • Practical experience using hospital information systems, Epic billing system preferred, and computer proficiency with PC applications (e.g. Microsoft Office).

Education, Licenses and Certifications:

  • Bachelor’s degree in related area and/or equivalent experience/training (required)
  • Master’s degree in related area and/or equivalent experience/training (preferred)


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