• Job Description

  Req#: 1100
  The main purpose of this position is to support PHRS's mission, vision, core values and customer service philosophy.
  
  The responsibilities of a Revenue Optimization Specialist include, but are not limited to, posting, applying and filing payments; processing transfers when appropriate and balancing deposits. The ideal candidate for this position will have a good understanding of accounting and possess the ability to balance and reconcile accounts on a daily basis. This position also requires the employee to be detail-oriented and be capable to multi-tasking. The most qualified candidate for this position will demonstrate strengths in the following areas:
  
  • Leadership skills
  • Ability to meet deadlines
  • Professional appearance and attitude
  • Strong and effective communication with clients, customers, patients, co-workers and management staff.
  
  CUSTOMER SERVICE :
  
  • Accountable for outstanding customer service to all external and internal customers.
  • Develops and maintains effective relationships through effective and timely communication.
  • Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
  
  PRINCIPAL RESPONSIBILITIES AND DUTIES :
  
  • Responsible for working with staff to identify trends and issues and report them to the cash manager
  • Ongoing motivation and training to staff.
  • Identify and resolve problems and inconsistencies and implement appropriate corrective procedures to resolve.
  • Functions as a liaison between upper management and position leads regarding revenue cycle issues.
  • Functions as a liaison between the client and associated client professional organizations, such as vendors, credentialing contacts, and other agencies as needed.
  • Is current on all payer bulletins and communicates pertinent information to staff, peers and management
  • Prepares training material for all job functions, including PM system, payer portals, and any other internal and external resources required for the team to function at the highest level of proficiency.
  • Trains or instructs current and new employees in job duties or company policies or arrange for training to be provided
  • Interprets and communicates work procedures and company and client policies to staff.
  • Makes recommendations to upper management concerning such issues as staffing decisions or procedural changes.
  • Completes all tasks assigned by the Cash Manager in a timely manner
  • Communicates any issues to the Cash Manager for tasks or other performance related that will extend a deadline or adversely affect revenue
  • Improve organizational performance by identifying opportunities for improvement in the revenue cycle process
  
  
  ESSENTIAL ROLE FUNCTIONS:
  
  Monitors work queue, and or other reports, for adverse activities or trends, and communicate any to the cash manager
  
  • High level alertness for adverse activities or trends
    1. Examples: (not exhaustive)
       • Explanation of Benefits are not being posted in a timely manner
       • Zero or No pays are not be posted in the PM system
       • Volume of missing EOB's and EFT's
  • Training and continuing education for the cash staff
  
  EDUCATION :
  
  High School diploma or equivalent is required.
  
  • Associates Degree in Medical Billing and Coding or a related field is preferred.
  
  PHYSICAL DEMANDS AND WORKING CONDITIONS:
  
  The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  
  Employee must be able to sit at a desk for at least eight hours per day while frequently using their fingers to type. This position requires that the employee be able to speak clearly, look at and read a computer screen. Occasionally, this position may require that the employee reach or stretch for objects.
  
  EXPERIENCE AND REQUIRED SKILLS :
  
  • 5-7 years of experience in medical billing office or related environment.
  • Must have a thorough understanding cash process for RCM services
  • Candidate must understand government and managed care payment methodologies and demonstrate knowledge of terms such as contractual adjustment, allowed amount, coinsurance, denial and denial processes.
  • Knowledge and ability to stay abreast of HIPAA laws and regulations and maintain compliance
  • Attention to detail to ensure accuracy of information
  • Excellent MS Suite skills including Excel, Word, and Outlook
  • Proven analytical skills
  • Ability to present, communicate initiatives, results and analyses to multiple levels of management and clients
  • Current working knowledge in medical professional claims processing, payment posting, collections and A/R Follow up
  
  ACTING MANAGER FOR VACATION/PTO COVERAGE:
  
  All revenue cycle employees including: Lead A/R, Lead Charge Entry Specialist, Lead Cash Applications Specialist, Customer Service, Charge Entry, Cash Applications, Accounts Receivable, Credentialing and Coding.
  
  Pinnacle Healthcare Consulting is an Equal Opportunity Employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition, or any protected category prohibited by local, state, or federal laws.

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