Billing Operations Revenue Specialist

Job description

Department: 13265 Enterprise Revenue Cycle - Enterprise Billing Compliance: HB Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: M-F, 8:00-5:00 Pay Range: $25.30 - $37.95 Advocate Aurora Health candidates must live in these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL*, IN, KS, KY, LA, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Major Responsibilities: Coordinate identification, research, and resolution of claim underpayments across government payers Submits claims for Hospital at Home and CAR-T Manages AR and billing for connect sites Process consecutive claims, overlaps, inter-facility and Room and Board changes Submit timely requests for reprocessing and follow-up on underpaid claims. Prioritizes outstanding AR with focus on complex, aged and high dollar accounts. Analyze root causes of underpayments and recommend preventative measures. Develop and implement processes for appeals and denial payment recoveries. Prepare and submit appeals for technical denials, AI and regulatory compliance. Monitor and manage audit responses for non-government payers. Maintain internal audit tracking communicate audit activity to stakeholders. Research accounts, payer guidance and federal/state regulations impacting reimbursement. Provide actionable insights to leadership for margin improvement and compliance. Partner with revenue cycle teams to educate staff on billing, collection, underpayment and denial prevention strategies. Meets established quality and productivity standards and collaborates with teammates to achieve shared goals and metrics. Studies, reports, and make recommendations regarding compliance and/or revenue improvement. Supports overall revenue cycle efforts surrounding the development and integration of new and innovative approaches to using people, processes and technology to increase net revenue. Participates in special projects as deemed appropriate. Certification Required: None Education Required: High School Diploma or General Education Degree (GED) Work Experience Required: Typically 5 years of experience in healthcare billing, revenue cycle, underpayments, denials management. Knowledge, Skills & Abilities Required: Proficient in MS Office Strong knowledge of healthcare reimbursement methodologies, billing compliance, payor contracts, and regulatory guidelines. Expertise in denial management, audit compliance, and payment resolution. Advanced analytical and problem-solving skills Excellent communication and collaboration abilities across multidisciplinary teams. Ability to manage multiple priorities and drive process improvements. Physical Requirements and Working Conditions: Typical office environment This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview. About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.