[Hiring] Revenue Cycle Specialist I @CorVel Career Site

Role Description

The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues. This is a remote position.

• Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines.
• Establish and maintain accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims.
• Identify errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners.
• Perform contract and reimbursement variance analysis.
• Analyze claims data to identify contractual overpayments and billing errors.
• Assist department and leadership in obtaining complex information from various financial, clinical, and operational systems and data sources.
• Learn or remain current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing.
• Provide subject matter expertise on billing and coding guidelines and regulations as required by the department.
• Use internal and external billing protocols and regulations for repricing bills at a cost savings to the customer.
• Identify trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing.
• Establish and maintain detailed knowledge and documentation of all analysis/data sources within the department.
• Analyze all forms of Revenue Cycle transactions.
• Possess the ability to run standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders.
• Produce daily, monthly, and annual evaluative and statistical reports, analyzing drivers of variances from period to period to ensure the integrity and accuracy of revenue cycle data.
• Evaluate integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances.
• Ensure strict confidentiality of all medical records, PHI, and PII.
• Additional duties as assigned.

Qualifications

• Ability to work independently and use critical thinking.
• Detailed knowledge of pay reimbursement methodology.
• Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable).
• Strong understanding of healthcare revenue cycle and claims reimbursement.
• MS Office includes Word, PowerPoint, Excel and Outlook, Windows operating system and Internet.
• Strong analytical and problem-solving skills.
• Strong attention to detail and ability to deliver results in a fast-paced and dynamic environment.

Requirements

• Claims repricing, pricing configuration, or provider maintenance experience required.
• 3+ years of relevant experience or equivalent combination of education and work experience.
• High School Diploma or equivalent required.
• Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable.

Benefits

• Comprehensive benefits package for full-time regular employees.
• Medical (HDHP) w/Pharmacy.
• Dental, Vision.
• Long Term Disability.
• Health Savings Account, Flexible Spending Account Options.
• Life Insurance, Accident Insurance, Critical Illness Insurance.
• Pre-paid Legal Insurance.
• Parking and Transit FSA accounts.
• 401K, ROTH 401K.
• Paid time off.

Company Description

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).