Revenue Cycle Services Specialist 1

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Job Title:

Revenue Cycle Services Specialist 1

Department:

East Precert and Financial Counseling

The Ohio State University Health System is committed to improving access and service to customers. The Revenue Cycle Specialist functions as an integral member of the health care team to reflect a culture of cooperation, enthusiasm and mutual respect. This position will provide follow-up to denials and help resolve ongoing billing and payor issues. The Revenue Cycle Specialist position is responsible for resolving issues related to authorizations, utilization review requirements, billing and compliance within the revenue cycle for OSU Health System through using quantitative and qualitative analysis techniques. They support the OSU Health System in meeting objectives of a successful and compliant revenue cycle through increasing cash on hand, lowering AR days, and lowering rejections/denials. This position provides support, intervention and follow-up on a variety of processes that impact the revenue cycle including authorization review, analysis, and combining/uncombining accounts.

Position Summary:

The Revenue Cycle Specialist is responsible for a wide variety of functions that primarily revolve around analyzing and resolving issues with accounts that involve authorization, billing and compliance. This position serves as an expert in understanding the payers requirements and works with various other departments to identify issues and resolve them prior to billing or after a denial is received. This position is responsible for independently providing a higher-level review of all medical necessity and authorization denials to determine a root cause for the denials. This position analyzes data to identify historic trends, perform comparisons against identified standards, and assists in formulating strategic plans for appealing denials.

This position uses expert knowledge of payer authorization requirement to write and submit appeals for administrative authorization denials. Identifies and develops appropriate tools to track issues, analyzes workflows, identifies logistical and operational issues to target for improvement. Further, this position is responsible for reviewing accounts with various claim errors that require a second higher-level review. This can include claims with admission or discharge date discrepancies, admission order timing issues, or various other regulatory compliance issues.

This position is also responsible for interdepartmental/intradepartmental communication and process improvement throughout the revenue cycle. This position must become competent in all available systems where revenue cycle information is held, including Midas and EPIC modules for Cadence, ADT, Ambulatory, and Resolute.

Minimum Required Qualifications:

For Hire: Bachelors Degree in Business or Health Care Administration OR equivalent combination of education and experience. Master’s Degree in Business or Operational Efficiency highly desired. 2-3 years of operational experience within the Revenue Cycle. Familiarity with the DMAIC process and lean tools and concepts. Lean/Six Sigma certification and/or experience highly desired. Must possess excellent analytical skills, good written and oral communication skills. Must possess knowledge of process mapping/value stream mapping tools. Proficient with computer information systems, preferably Epic, and Microsoft Word, Excel and PowerPoint.

Additional Information:

Location:

East Hospital - Main (0398)

Position Type:

Regular

Scheduled Hours:

40

Shift:First Shift

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

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The university is an equal opportunity employer, including veterans and disability.

As required by Ohio Revised Code section 3345.0216, Ohio State will: educate students by means of free, open and rigorous intellectual inquiry to seek the truth; equip students with the opportunity to develop intellectual skills to reach their own, informed conclusions; not require, favor, disfavor or prohibit speech or lawful assembly; create a community dedicated to an ethic of civil and free inquiry, which respects the autonomy of each member, supports individual capacities for growth and tolerates differences in opinion; treat all faculty, staff and students as individuals, hold them to equal standards and provide equality of opportunity with regard to race, ethnicity, religion, sex, sexual orientation, gender identity or gender expression.

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