Professional Billing Project Specialist

Job Description

Assist leadership and staff with special projects. Communicate, facilitate, and trouble shoot trends. Partner with internal and external customers to decrease waste and add value in revenue cycle operations. Develop assessment tools and processes to be utilized in quality improvement efforts.

Responsibilities

OPERATIONS

• Conduct PB and Collections special projects. Work projects through design, completion, reporting, and resolution in a timely manner. Coordinate with PB managers and staff to achieve desired results.
• Identify inefficiencies within PB Revenue Cycle. Identify automation enhancement opportunities and lead implementation.
• Assist Revenue Cycle Director as needed with research and provide feedback on issues and resolution.
• Analyze revenue cycle key performance indicators (KPIs) including, but not limited to:
• Days in Accounts Receivable (AR)
• Denial rate
• Clean claim rate
• Net collection rate
• Identify opportunities related to cash acceleration, standard work, process improvement, and technology adoption.
• Work with PB leadership team to ensure appropriate and up-to-date policies and procedures are in place.
• Work under fast-paced circumstances to meet deadlines.
• Report unit-specific statistics as defined by leadership.
• Communicate with unit leadership regarding process and procedures.
• Assist with development, revision, and maintenance of unit training materials, policies, and procedures.
• Demonstrate an understanding of TCHHN, departmental, and unit policies and procedures. Seek clarification as needed.
• Comply with regulatory, legal, and accreditation requirements. Seek clarification as needed.
• Assure compliance with safety programs.
• Maintain currency with work processes, tools, and clinical and administrative applications necessary to perform job functions.
• Participate in and demonstrate an understanding of continuous quality improvement/Lean Thinking concepts.
• Demonstrate initiative by continuous expansion of knowledge and skills.
• Participate in departmental/unit activities including, but not limited to, staff meetings and in-services.
• Perform other duties as assigned in order to maintain the efficiency of the department.
  

CUSTOMER SERVICE

• Advises leadership, unit staff, and other customers, handles escalated issues including research and follow up with patients.
  
  

SKILL SET

• Attention to Detail: Achieves thoroughness and accuracy when accomplishing a task.
• Data Management: Acquires, validates, and processes data so its accessibility, reliability, and timeliness are ensured to satisfy the needs of end users.
• Analysis: Analytical skills with the ability to visualize, articulate, and solve complex problems and concepts and make decisions based on available information.Ability to analyze detailed information to determine appropriate compliance with privacy and security rules.
• Critical Thinking: Gathers and integrates critical information to arrive at effective solutions.
• Decision Making: Makes timely, informed decisions that consider the facts, goals, constraints and risks.
  
  

Qualifications

Education: High school diploma or equivalent required.Associate’s degree in a healthcare- or business-related field preferred.

Years of Experience:Minimum of seven years of Revenue Cycle experience.

Required Skills and Knowledge:

• Knowledge of standard medical terminology, medical treatments, methods, medical documentation requirements, and data collection techniques.
• Ability to read and understand complex medical documentation.
• Demonstrated ability to collect and analyze claims and medical information from a variety of applications and make independent judgments as to what is missing, (non-)compliant, or the appropriate next step to identify or resolve an issue.
• Proficiency using Microsoft Office applications for work tasks.
• Ability to work independently and on a team with minimal supervision.
• Ability to work under pressure and meet deadlines.
• Demonstrated ability to communicate up, down, and across the organization in order to provide assistance where needed.
• Knowledgeable of Medicare, Medicaid, MA, MCO, and commercial billing requirements.
• Experience using Epic and billing clearinghouse software preferred.