Revenue Specialist

SBHU•East Setauket, NY

About The Position

At Stony Brook Medicine, a Revenue Specialist will provide operational support within the hospital’s Patient Accounting Department. The position will support day-to-day business functions including but not limited to\: billing, claims analysis appeals, follow-up, financial assistance and customer service. Duties of a Revenue Specialist may include the following, but are not limited to: Prepare and submit hospital claims. Review denials. Investigate coding issue. Audits. Follow-up on rejected or denied claims, improper payments and coding issues. Process appeals. Liaise with third party billing and collection agencies. Identify issues and patterns with claims/insurance companies and review to increase revenue and prevent unnecessary denials. Assist the supervisor in scheduling, timesheet, leave requests, performance programs and evaluations. Assist the supervisor in training and make recommendation to improve policy and procedures for the unit as well as the office. Investigate and accurately update COB, including refund request letters, reports, mail, etc. Other duties as assigned.

Requirements

Bachelor’s degree in Accounting, Business, Health Information Management or related field with a minimum of 6 months business experience, preferably in a healthcare setting; or an Associate's degree and at least 6 months of business experience, preferably in a healthcare setting such as revenue cycle, medical billing, or follow-up experience; or in lieu of degree, at least 2 years of business experience, preferably in a healthcare setting such as revenue cycle, medical billing, or follow-up experience.
Excellent written and oral communication skills.
Proficiency with Microsoft Office.
Has in depth knowledge and experience with investigating, reviewing, and following up on rejected/denied insurance claims and/or experience using claims scrubber system.

Nice To Haves

Experience investigating, reviewing, and following up on rejected, denied insurance claims and/or experience using claims scrubber systems.
Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies.
Knowledge of third party payer reimbursement and managed care contracts.
Experience investigating, reviewing and following-up on rejected/denied inpatient and outpatient hospital claims.
Knowledge of CPT, HCPCs and ICD-10 coding principles.
Experience with Cerner Invision and/or Cerner Millennium Patient Accounting.
Experience in Insurance Verification.
Experience working in Medicare FSS DDE system.

Responsibilities

Prepare and submit hospital claims.
Review denials.
Investigate coding issue.
Audits.
Follow-up on rejected or denied claims, improper payments and coding issues.
Process appeals.
Liaise with third party billing and collection agencies.
Identify issues and patterns with claims/insurance companies and review to increase revenue and prevent unnecessary denials.
Assist the supervisor in scheduling, timesheet, leave requests, performance programs and evaluations.
Assist the supervisor in training and make recommendation to improve policy and procedures for the unit as well as the office.
Investigate and accurately update COB, including refund request letters, reports, mail, etc.
Other duties as assigned.