Revenue Cycle Specialist - NonExempt

Summary/Objective

The Revenue Cycle Specialist provides leadership, direction, and support for delivering world class results while providing efficiency and effectiveness for the Revenue Cycle operations within the Revenue Cycle function of NorthShore Health Centers. This includes related activities specific to all billing, collections, secondary billing, A/R resolution and cash flow with respect to billing and the accurate presentation and maximization of the Revenue Cycle results.  These associates will work closely with all operational areas within NorthShore Health Centers and the NSHC revenue cycle function such as pre-service clearance, financial management reporting, patient satisfaction, Patient Access, coding and the payors to apply new and emerging approaches for the NorthShore Health Centers clinical, administrative, financial and operational areas. Further responsibilities include identifying, analyzing, and resolving all operational issues associated with the internal processing of accounts receivable while insuring annual cash flow.

The Revenue Cycle Specialist will actively look for opportunities to maximize revenue throughout the system to transform the patient experience with a focus on improving both the patient experience and satisfaction as well as providing accountability for strategic business units that impact the patient experience and service pillars of the organization. The incumbent will focus on opportunities to maximizing the patient experience and patient revenue by strategically re-engineering the revenue integrity processes to improve the patient experience, increase patient volumes and retain current patients by expanding the services in question.

The Revenue Cycle Specialist will exhibit behaviors consistent with the standards for organizational values of NorthShore Health Centers. Demonstrates actions consistent with NorthShore Health Centers “expectations” as duties are performed on a daily basis.

Scope of practice includes the following areas:

• Billing and Collections
• Revenue Leakage – (Denials, Missing Charges and Payment Variances)
• Patient Service Call Center
• Cash Application
• Guarantor/Self-Pay Collections/Medicaid Eligibility
• Payor Audits
• Denial Resolution
   

Essential Functions

• Establish the parameter of the job in conjunction with NorthShore Health Centers senior management.
• Independently identify issues, seeks solutions and acts to solve the various issues.  The incumbent will be proactive in problem remediation and act with the Manager and Directors knowledge or permission and inform management of actions at a later time.
• Provides leadership and recommendation to revenue cycle leadership.
• Responsible for the successful development and implementation of operating and capital budgets, goals, objectives, policies and procedures including monthly review, and analysis.
• Providing updates and the necessary education, industry benchmarks and best practices to Revenue Cycle management including the respective operational leaders.
• Provides feedback and updates on a regular and consistent basis concerning current operations. Demonstrates a strong orientation to working with fellow associates in a positive and participative manner, modeling behavior that is consistent with the organization’s mission and values.
• Maintains confidentiality in matters specified by law and hospital policy, especially those relating to information about sensitive patient and/or financial data.
• Interacts with patients/families, staff, and vendors with a variety of developmental and socio-cultural backgrounds.
• Maintains professional relationships and convey relevant information to other staff within the facility and applicable agencies.
• Works closely with other NorthShore Health Centers departments to insure the success of the patient experience and the maximization of patient revenue. 
• Demonstrates positive interpersonal relations in dealing with physicians, patients, patient families, visitors, co-workers, executive staff, hospital volunteers, employers, insurance companies, legal community, legal counsel, and governmental entities.
• Develops interdependent relationship with other NorthShore Health Centers departments and revenue cycle, as needed.
• On-going involvement and required participation with respect to industry related groups and functions.
• Develops in-conjunction with senior management an on-going personal development and succession plan.
• Participates in the creation of a staff development to more fully develop and internal resources to fulfill long term objectives of the organization.
   

*These essential functions are a summary of the primary duties and responsibilities of the position, and are not intended to be a comprehensive listing of all duties and responsibilities.  The position will include other duties as assigned and duties are subject to change at management's discretion.

Competencies

• Planning and strategic foresight
• Responsible Decision Making
• Integrity and accountability
• Innovation and creativity
• Adaptive and flexible
• Leadership, teamwork, and conflict resolution
• Professionalism and work ethic
• Empathy

Work Environment

Work is performed in an office environment. Involves frequent personal and telephone contact with patients, physicians, and other healthcare personnel. Work may be stressful at times. Interaction with others is constant and interruptive.

Travel

Travel outside of Northshore locations will be rare for this position.

Role Qualifications

• Must be at least 18 years of age
• Must have reliable transportation
• Digital literacy

Preferred Experience Requirements

Minimum of 2 years’ relevant experience that includes extensive knowledge of hospital and professional fee revenue cycle or health care finance/operations experience and regulatory requirements as they relate to the revenue cycle, health care operations and the clinical enterprise.  Experience preferred within a similar setting of size, volume and organizational structure. Prefer but not required that the individual have significant experience with payors, providers, hospitals and physicians and understand the commensurate requirements for facilitating hospital and professional revenue cycle operations, health care financial operations, revenue management operations, analysis and the corresponding operational activities, financial compliance auditing, accounts receivable resolution, cash flow, billing, revenue enhancement and patient service issues.

Minimum Education Requirements

High school diploma (or the equivalent)

Preferred Education Requirement

Bachelor's degree in accounting, finance or management preferred. Health Care Certification including, but not limited to CHAM, CHAA, FHFMA desired.

Required Skills

• Ability to analyze situations and solve problems at strategic and tactical levels
• Excellent interpersonal and customer service skills
• Ability to comprehend, interpret, and apply the appropriate sections of applicable laws, guidelines, regulations, ordinances, and policies
• Ability to acquire a thorough understanding of the organization's hierarchy, jobs, qualifications, compensation practices, and the administrative practices related to those factors
• Practiced at organization and planning
• Employ Critical thinking and problem solving
• Maintains composure and operates with emotional intelligence
• Ethical reasoning and decision-making
• Strong attention to detail
• Receptive and responsive to feedback
• Excellent verbal and written communication skills
• Time management, prioritization, and sense of urgency
• Proficient with Microsoft Office Suite or related software
   

Physical Requirements

While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening/weekend shifts.  Work may include hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear.  The employee must occasionally lift and/or move up to 50 lbs.  While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.