Recovery Centers of America at King of Prussia
Position Overview: The Operations Revenue Cycle Specialist functions out of the Recovery Centers of America (RCA) Corporate office and is responsible for collaborating with all sites to provide support, identify operational gaps, ensure operational processes are being followed, and implement new or adjusted processes/protocols related to front end revenue cycle management. The Operations Revenue Cycle Specialist will collaborate with RCA Corporate teams including Finance, Patient Accounts, and the Mission Center leadership to document, train, and provide oversight of operational processes and procedures that impact the RCA sites’ management of insurance authorization, financial set up, verification of benefits, collection of patient financial responsibility, data entry in Avatar, and other related tasks that impact billing and utilization management. A major focus of the Operations Revenue Cycle Specialist is ensuring all RCA programs are maximizing their capacity to provide and receive payment for treatment without barriers by acting as a liaison daily with utilization review, financial counselor, admissions, verification of benefits, and billing staff. Additionally, this position is required to monitor adherence to existing RCA operational protocols related to accurate authorization and financial set up data entry in the Electronic Health Record (EHR), management of unbilled items across programs, Finpay or other payment plan processes as identified, trends in utilization review issues, and oversite of denied days and outstanding chart appeal and Cobra authorizations. The Operations Revenue Cycle Specialist will work closely with both Corporate teams and RCA site Leadership/Management to ensure all RCA programs are following all protocols and policies developed by RCA senior leadership, and ultimately to ensure the patient treatment experience is aligned with the RCA Mission at all RCA programs. This position will assist with training or auditing needs based on operational policies and procedures and/or quality assurance plan of corrections.
- Thoroughly understand processes, policies, and procedures related to overall facility operations for all RCA programs and levels of care.
- Maintain updated documentation of operational workflows for Utilization Review, Financial Counselors, Admissions, and Finance/Billing.
- Facilitate on-site support to ensure adherence to all protocols with the result of all treatment being properly funded and documented for billing purposes
- Monitor and correct any and all issues related to unbilled items, chart appeal management, Finpay processes, and patient days denied for payment by insurance companies.
- Identify and document and trends related to utilization review and financial counselor issues that deviate from target goals.
- Conduct internal audits of operational processes as needed in collaboration with supervisor and identify areas in need of improvement.
- Articulate results of internal audits and collaborate with other RCA Departments to establish plans for improvement.
- Provide support to Operations Team to ensure RCA mission, goals, and objectives are achieved.
- Provide reliable trending analysis of current and past data including, but not limited to, length of stay and days authorized by specific insurance companies, denied days and appeals by specific insurance companies.
- Consistently work to assist with the development of new and innovative systems/processes to help maximize patient days.
- Exhibit knowledge of all continuums of care, including admission assessment and continued stay criteria.
- Work closely with site Admissions, UR, and other members of the treatment team to ensure appropriate utilization of services.
- Share knowledge and experience working with in-network and out-of-network benefits to help maximize patient days.
- Validate all efforts to obtain authorization, authorized days, and details related to insurance denial and appeal efforts are documented clearly and thoroughly in the EHR.
- Provide insight and communicate all utilization challenges or concerns that may compromise patient’s treatment immediately and those which will impact proper billing of services
- Work harmoniously with colleagues, supporting colleagues as appropriate and balancing individual and team goals
- This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Education and Experience:
- Bachelor’s degree and 3+ years’ related experience
- Excellent verbal and written communication skills.
- Excellent organizational skills with the ability to prioritize workload
- Proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
Customer Service: Demonstrates concern for meeting internal and external customers’ needs in a manner that provides satisfaction for the customer within the resources that can be made available.
Problem Solving: Identifies problems, involves others in seeking solutions, conducts appropriate analysis, searches for best solutions; responds quickly on new challenges.
Communication: Comfortable using a broad range of communication to different audiences in diverse solutions.
Project Management: Coordinates the diverse components of the projects by balancing scope, time, cost, and quality.
Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or out-patient facilities. They spend much of their time on their feet, actively working with patients.
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected