Revenue Cycle Specialist

Summary

Job Description:

Baptist Health is looking for a Revenue Cycle Specialist to join their team. This is a remote work position that requires residency in KY or IN

Research denials from all commercial and governmental payors. Performs payor compliance review onaccounts to determine medical necessity of services, pre and post service as well as pre and postbilling. Obtains pre-determinations, prior authorizations, and retro authorizations when required bypayor. Responds to all account reviews with the best possible efforts to ensure reimbursement,recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor orgovernment timelines. Recovery efforts include but are not limited to written letter, email, web site, andtelephonic communication.

Qualifications:

• Bachelor's Degree in related field,Practical Nurse License, or CodingCertification with two years healthcare experience required.

• In lieu of Bachelor's degree, five years of healthcare experience required including two years in a revenue cycle related area such as registration, patient financial services, or managed care.

• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity,and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts.Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.

Work Experience

Education