Revenue Operations Specialist: Billing & Denial Expert

AHRC New York City; New York (NY); On-site; USD 55,000 - 60,000; Full time

Job summary

AHRC New York City is seeking a Revenue Operations Specialist to mentor Revenue Operations Coordinators and provide back-up to the Revenue Operations Manager to ensure billing and posting deadlines are met.

The role spans multiple billing systems, external payer portals and government sites, handling eligibility, billing, posting, appeals and denials management, while identifying trends to improve efficiency and cash flow.

Qualifications

• Analytical problem solving to diagnose and troubleshoot root problems with process, payer and system functionality that impacts revenue cycle objectives.
• Associate Degree in Healthcare Administration, Business Administration or equivalent job-related experience. (Bachelors Degree desired)
• Minimum of three years experience in a physicians office, clinic, hospital business office or related area dealing with insurance follow up and denial management or two years experience in Atypical billing, OPWDD, Medicaid Waiver, Article 16, and/or Article 31 billing and denial management.
• Applied intermediary to expert level experience Microsoft Word and Excel.
• Strong adaptability to old and new billing so

Responsibilities

• Serves as super user of the billing software systems and acts as a mentor and resource to other team members and department-based users in development of skill sets and application knowledge.
• Analytical investigation and necessary action for rejected or denied claims including but not limited to:
• Submission of an appeal to the original decision,
• Correction of the original submitted claim for resubmission to the payer,
• Secondary billing post response received from the Primary payer, or
• Completion of self-pay billing or write-off action to resolve the claim.
• Review of system aging accounts on a weekly basis to conduct appropriate follow up activities.
• Apply analytical strategies for the identification of inconsistencies or trends in weekly billing and posting activities that may present system functionality issues or identifies a breakdown in program/clinic practices that may be negatively impacting billing or collection.
• Collaboration with inter-agency departments regarding billing, collections, and compliance matters.
• Prepares self-pay, liability billing or other forms of vouchers and billing as needed.
• Medicaid, Medicare and / or Managed Care billing, posting and reconciliation across multiple billing systems, clearinghouses and/or billing portals.
• Works with the compliance department on billing changes, voids or write-offs that may be necessary to complete and perform the applicable action.
• Works with management to improve billing practices, guidelines, and department procedures to ensure efficiency, reduce denials, maximize reimbursements and promote faster payments.
• Assist in the training or retraining to current and new employees on use of systems and departmental policies and procedures.
• Independently lead initiatives assigned by management, coordinate tasks as necessary to deliver results.
• All team members are responsible to perform back-up duties as defined to cover for vacancies, vacations, extended leave of absences or as the department requires to maintain billing deadlines.
• Perform ad-hoc tasks as assigned.
• Strong adaptability to old and new billing so

Skills

Analytical problem solving

Microsoft Word

Microsoft Excel

Adaptability

Education

Associate Degree in Healthcare Administration, Business Administration or equivalent

Bachelor's degree desired

Job description

AHRC New York City is seeking a Revenue Operations Specialist to mentor Revenue Operations Coordinators and provide back-up to the Revenue Operations Manager to ensure billing and posting deadlines are met.

The role spans multiple billing systems, external payer portals and government sites, handling eligibility, billing, posting, appeals and denials management, while identifying trends to improve efficiency and cash flow.