- Develops staff work listing logic, strategy and claims resolution work flows.
- Educates and trains new staff regarding departmental/unit policy and procedure, including: Managed Care Contracts.
- Monitors work queues and staff productivity to ensure work volumes and staffing are aligned.
- Audits staff work; provide education on best practice.
- Supervises junior staff. Completes employee performance programs and evaluations, scheduling and timesheets.
- Analyzes and identifies claim payment issues, patterns, and root cause; tracks and pursues un-timely, under-paid and denied accounts.
- Collaborates on denials prevention initiatives.
- Liaises with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials.
- Collaborates with the Managed Care Department, HIM and Patient Accounting leadership to address payment issues and resolve at risk/high dollar accounts.
- Analyzes new contracts and works with Contract Management system support to trouble-shoot contract rates and terms.
- Participates in Joint Operating Calls (JOC) with insurance payers.
- Monitors medical record request, correspondence distribution and scanning processes, volume, and trends.
- Assists in maintaining and creating payer report cards, claims tracking and management reporting as requested.
- Assists management reporting and special projects as requested.
- Bachelor's Degree and three years' healthcare revenue cycle experience, or in lieu of a Degree five years' of Healthcare Revenue Cycle experience resolving Hospital Managed Care payment variances and denials.
- Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies.
- Expert knowledge of third party reimbursement methodology and associated healthcare claim drivers.
- Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i).
- Experience working with CPT / HCPCs and ICD-10 codes.
- Experience working with Cerner Invision Patient Accounting.
- Proficiency in MS Office Suite including: Excel, Word.
- Excellent written and verbal communication skills.
- Experience working within Cerner Contract Management, Epic or equivalent including experience in validating the configuration and building of contracts.
- Medical Coding Certification through the American Academy of Professional Coders (AAPC).
- Proficiency with MS Access, Visio and/or PowerPoint.
- Knowledge of SQL or Database Queries.
- Experience reporting from healthcare decision support, patient accounting, contract management and/or claims scrubber systems.
- Proficiency with SAP Business Objects / Crystal Reports.
- Proficiency with visualization software (Tableau, MS Power BI, etc.)
- Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
- All Hospital positions may be subject to changes in pass days and shifts as necessary.
- This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
- This function/position maybe designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
- 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).
- The hiring department will be responsible for any fee incurred for examination.
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Senior Revenue Cycle Specialist - East Setauket, United States - Stony Brook University
Description
Position Summary
At Stony Brook Medicine, the Senior Revenue Cycle Specialist will act as an operational leader in the Hospital's Business Office to analyze, track, and pursue the payment of under-paid and denied accounts receivable.
Successful candidates will have a bachelor's degree and three years' healthcare revenue cycle experience or in lieu of degree 5 plus years' experience in an Acute Care Hospital Revenue Cycle or Patient Accounting Department resolving hospital Managed Care payment variances and/or denials.
Job Responsibilities may include the following, but are not limited to:Required:
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 on the application 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 were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.
______________________________________________________________________________________________________________________________________
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
In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here.
Stony Brook University Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.
Anticipated Pay Range:
The starting salary range (or hiring range) for this position has been established as - $ $44.62 / hour.
This position is benefits eligible.
The above salary range (or hiring range) represents SBUH's good faith and reasonable estimate of the range of possible compensation at the time of posting.
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