Professional Revenue Cycle Specialist

ATLANTICARE _____________________________________________ROLE DESCRIPTION POSITION SUMMARY . The Professional Revenue Cycle Specialist will be responsible for revenue cycle processes that support AtlantiCare professional revenue cycle areas as designated by leadership. This position will focus on ensuring and performing revenue cycle processes timely and accurately. The revenue cycle processes could include but are not limited to charge capture, analyze pre–bill edits, third-party denials, payment posting, claim processing and prepare relevant reports regarding trends based on the needs of the operational area as assigned. Revenue cycle specialist will be responsible to develop, produce, validate and distribute standard management and ad-hoc reports as requested by end-users and management This position will obtain, manipulate and analyze data from a variety of sources including but not limited to: electronic medical record system, physician & hospital billing systems, external vendor practice management systems, and payer claims portals. This position will handle questions, complaints, or problems and perform all tasks in accordance with industry standard best practices, AtlantiCare company policies, and departmental procedures. QUALIFICATIONS EDUCATION: High School Diploma, Associates Degree preferred. LICENSE/CERTIFICATION: Must have a maintained certification from HFMA or MGMA. Qualified certifications include but are not limited to: HFMA: CHFP, CRCR, or CSPPM MGMA: an ACMPE in revenue cycle, operations management, or financial management EXPERIENCE: 5 + years prior experience in professional revenue cycle, professional operations or other related healthcare experience. Excellent computer skills with high competency in MS excel. Strong communication skills. Revenue cycle basic knowledge is required at time of hire. PERFORMANCE EXPECTATIONS Demonstrates the technical competencies as established on the Assessment and Evaluation Tool. WORK ENVIRONMENT This position requires repetitive motion, fingering, hearing, pushing, reaching, reading, calculating, seeing, speaking, standing and walking a majority of the time. This position also works with such equipment as computer terminal, fax machine copier and telephone. Occasional driving also required. The essential functions for this position are listed on the Assessment and Evaluation Tool. REPORTING RELATIONSHIP This position reports to leadership in Professional Revenue Cycle The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

EDUCATION: High School Diploma, Associates Degree preferred. LICENSE/CERTIFICATION: Must have a maintained certification from HFMA or MGMA. Qualified certifications include but are not limited to: · HFMA: CHFP, CRCR, or CSPPM · MGMA: an ACMPE in revenue cycle, operations management, or financial management EXPERIENCE: 5 + years prior experience in professional revenue cycle, professional operations or other related healthcare experience. Excellent computer skills with high competency in MS excel. Strong communication skills. Revenue cycle basic knowledge is required at time of hire.