The Revenue Cycle Specialist will work as an integral part of an
interdisciplinary team to support the goals and protocols of the
revenue cycle workflow. The individual must be able to process large
quantities of data in order to monitor key performance Indicators and
research any and all barriers to successful revenue cycle management.
The candidate must possess the ability to work independently and
interchangeably across all MCO’s and workflows, with strong
organizational, communication and interpersonal skills.
- Under the guidance of the Revenue Cycle Manager, Specialists will
be responsible for various aspects of the entire revenue cycle, from
scheduling to accounts receivable.
- Working in conjunction with the Revenue Cycle Manager to complete
all MCO care gaps and reporting requirements.
- Support the Revenue Cycle Manager with appropriate coding and
billing related functions as needed to support Spectrums third party
- Use of MCO reports and practice registries to proactively identify
patients due or over-due for specific health services, contacts the
patients, motivates the patient to complete the recommendation, and
assists in scheduling appointments.
- Responsible for contacting new and established members identified
on the MCO listings and assure they are assigned to appropriate
provider panels and schedule appointments using EMR system using
patient demographic and insurance information as appointments are scheduled.
- Obtains all necessary appointment information and assures patients
are scheduled appropriately for evaluation, checking with clinical
staff when necessary for guidance.
- Monitor members to ensure that appointments are kept.
- Identifies patients that are out of care or in are elsewhere and
reports these patients to the MCO appropriately.
- Perform other functions as necessary including ad hoc duties.
- With the Revenue Cycle Manager, research and process claims
billing data, analyzing trends and identifying areas for
improvement. Communicate accordingly through prescribed avenues
based on organizational policy and process.
- Develop, process and maintain ongoing emergency room diversion
lists that Spectrum receives from our hospital partners including
contacting patients identified on the lists and scheduling appointments.
- Identify improvement opportunities based on performance metrics
- Remain flexible and adapt to changing MCO regulations and care gap protocols.
- Provide all necessary reporting and data required by the Revenue