Description
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Entity: Clinical Practices of University of Pennsylvania
Department: Emergency Department
Location: Hospital of the University of Pennsylvania- 3400 Spruce St
Hours: Full Time
Summary:
- The Revenue Cycle Specialist (RCS) provides billing knowledge, expertise and oversight in support of the department's effort to effectively manage its revenue cycle and ensure expedient claims processing and payment for services. The position performs a variety of functions including working the charge review work queues, resolving edits, rejections and department specific billing issues. The RCS serves as the billing liaison to the CFA and CBO responding to day-to-day billing inquiries and issues and assistance with EPIC APM related questions regarding work queue management as well as any billing issues related to benefit coverage, financial responsibility and account follow up.
Responsibilities:
FINANCIAL
- Complete understanding of all aspects of the Revenue Cycle.
- Understands Revenue Cycle, including but not limited to edits, rejections and Knowledge of Emergency Medicine Billing (both professional & technical components)
- Prepares supporting analysis and calculations for revenue cycle month-end review.
- Effective expertise in accounts receivable management.
- Meets established UPHS and Dept of Emergency Medicine standards for AR follow up on open invoices and resolution of edits and rejections with the goal of maximizing reimbursement and ensuring timely cash flow.
- Reviews various reports regarding Open AR, edits and rejections in order to identify AR problem areas and root causes.
- Responsible to monitor and resolve accounts on a daily basis
- Serves as a resource for all coding and billing inquiries
- Understands and utilizes Correct Coding Guidelines, insurance carrier policies and proactively uses carrier websites.
- Resolves edits and rejections related to, but not limited to, correction of registration, submission of documentation, acceptable Correct Coding Guidelines, timely filing, appeals reviews, verification of duplicate claims, maximum benefits, rejections due to precertification/authorization/ referral, provider eligibility/enrollment, Medicare and other miscellaneous rejections and edits.
- Develops reporting as needed from the Business Objects to assist Revenue Cycle in analyzing gross revenue and net revenue outcomes
- Provides assistance to department management throughout UPHS in assessing and interpreting departmental statistical data. Works closely with Finance, and Managed Care to communicate major changes and proposed changes to department processes.
- Reports, investigates, and assists in resolution of significant revenue cycle metrics variances identified through continuous monitoring reports. Coordinates front middle and back end analytics.
- Monitors all charge/revenue related work queues to ensure resolution of accounts is occurring in a timely manner.
- Assists in critical revenue cycle implementation projects involving completing revenue cycle assessments by reviewing current operations, conducting key interviews and reviewing the age trial balance to identify high value opportunities for improvement.
- Attends CPUP Revenue Cycle Education Class
- Assists in operations review and training as needed. REGULATORY COMPLIANCE: •In partnership with Penn Medicine, SOM, and the University, maintains accountability compliance with all federal, state and local regulatory standards and requirements, including JCAHO, Department of Health, funding agencies, FDA, HIPPA, HCFA, DPW, LCGME, SCGME, department specific guidelines and other.
CHANGE MANAGEMENT
- Flexible and readily adopts new processes and is engaged in practice operation changes
HEALTH SYSTEM INFORMATION SYSTEMS:
- Epic Applications-Electronic Medical Record, Registration, Scheduling and Billing •SAP – Business Objects
- Payer Electronic Verification Systems-Navinet, etc.
Credentials:
Education or Equivalent Experience:
- H.S. Diploma/GED (Required)
- 4+ years experience in accounting or financial reporting (health care preferred)
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.