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Department

Job Summary

The Revenue Cycle Specialist Senior works under general supervision. This incumbent provides financial, clerical, and administrative services to ensure efficient, timely and accurate reimbursement of all inpatient/ outpatient hospital and physician claims submitted by Hospital and Physician Services. The incumbent corresponds with insurance companies, patients, guarantors, providers, attorneys, and other partners to resolve unpaid balances in a timely manner. Delivers customer service, billing, follow-up, cash application processes, reconciliation of payer remittances, denial management and appeal functions. Provides financial guidance on self-pay accounts. Investigates delinquent accounts for legal liability. This role requires exceptional knowledge of insurance rules, payor specific guidelines, regulatory requirements, claim submission, processing, and collections. Individuals in this role must possess strong attention to detail and excellent communication skills, both verbally and in writing. This position requires an individual that can correspond professionally and competently on escalated issues/concerns, as well as higher level detailed situations. This role serves as a resource and mentor for junior members. Assists in leading and openly supporting management in projects, training, and organizational initiatives to achieve departmental and cash goals.


Essential Functions:

• Conducts a thorough investigation by obtaining accident reports, contacting patients, attorneys, and insurance companies. Ensures hospital liens and notices are submitted timely and accurately to avoid loss of revenue. Completes requests for itemized statements, billing ledgers and claims. Consistently documents contact with all parties involved. Initiate collections by contacting and negotiating with third party payers, debtors or designated representatives and attorneys.. (45%)
• Completes worklists and/or reports as assigned. Performs deep-dive analysis of KPI's, identify underlying drivers, uncovers new insights, and makes data-driven recommendations to stakeholders which results in improved business and performance. (25%)
• Responds to inquiries and complex questions and collaborates with Supervisor to develop training material and standard of work for the department. Builds trusting relationships with internal and external departments/ business partners by providing confident leadership and timely communication. (15%)
• Utilizes various payer systems, provider portals, and internal applications.
  (10%)
• Reviews websites, bulletins, etc., to keep current knowledge of regulatory requirements. Relays updated information to key stakeholders regarding policy changes. (5%)

Education:

• High School Diploma or GED Required

Work Experience:

• 4-6 years Four years minimum of hospital/ medical office experience, with an emphasis on claim submission, insurance follow up, insurance denials and credit balances. Required

Licenses:

Knowledge, Skills and Abilities:

• Intermediate knowledge of insurance billing, insurance processing and practices, payor rules and regulations related to claim processing and applicable insurance definitions.
• Must have strong written and verbal communication skills, analytical thinking, high level of computer accuracy, and organization and problem solving skills.
• Ability to prioritize work activities with minimal supervision in an individual and team setting.
• Ability to utilize various software applications and information systems to perform work processes.
• Working knowledge of accounts receivable databases. Skill sets to include 10-key by touch and typing a minimum of 35 words per minute (WPM).
• Attention to detail and ability to demonstrate professional work behavior.

Shift

Work Type

Salary

Benefits

• Competitive pay

• Outstanding benefits

• Education opportunities

• Shared leadership and advancement opportunity

• State-of-the-art facilities

• Immediate retirement plan matching

• Professional clinical advancement program

• Participation in evidence-based projects

• Public Service Loan Forgiveness (PSLF) eligible employer

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).

Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For read more about our commitment to diversity visit: https://www.denverhealth.org/for-professionals/careers/diversity-and-inclusion

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About Denver Health

Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation's leaders in medicine.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.

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