Revenue Specialist Job Description
Revenue specialist
provides ongoing professional fee education covering changes in billing and reimbursement rules, state and federal legislation, and billing software applications.
Revenue Specialist Duties & Responsibilities
To write an effective revenue specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included revenue specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
Prepares reports, and provides departmental summary information to the Revenue Cycle team which is responsible for ensuring that all charges on a system-wide basis are being captured, charged and reimbursed appropriately and for overall compliance
Acts as operational leader in new practice acquisition process.Prepares operational assessments of current operations and prepares the new practice for changes in the future state.Provides on-site support at go-lives to ensure practice staff are following new processes and utilizing the Flowcast system in an efficient manner
Provides guidance and advice to departmental Revenue Cycle Managers and/or staff
Identify opportunities for business planning purposes
Maintain Prior Authorization Payer Rule Spreadsheet including calling providers to understand rules to populate the spreadsheet
Work with all required (intradepartmental & interdepartmental personnel to identify charge capture / reimbursement issues and to define resolution approach using available mechanisms [EpicCare, Epic PB, Epic HB, ORCA charge utilization reports, Epic BOE / SSRS reports, Charge Capture Audit (CCA) edit analysis
Perform analysis and troubleshooting for charge capture / missing charge resolution and denial / write-off mitigation
Monitor chargemaster revenue and usage and Epic / EpicCare charging and billing data to monitor performance
Assist with the documentation of new operational procedures / processes related to charge capture
Provide status updates to management and key stakeholders
Revenue Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Revenue Specialist
List any licenses or certifications required by the position: AAPC, CHAM, CRCR, CHC, RN, CHAA, CRC, CCA, LPN, CPT
Education for Revenue Specialist
Typically a job would require a certain level of education.
Employers hiring for the revenue specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Accounting, Business, Finance, Associates, Education, Management, Healthcare, Business/Administration, Healthcare Administration, Communication
Skills for Revenue Specialist
Desired skills for revenue specialist include:
State
Insurance rules
Insurance reimbursement and authorization process
Healthcare reimbursement accounting principles
Managed care payers in multiple states
Medical billing and reimbursement practices
Regulations for federal
Revenue cycle
MS office applications
Specifically Excel
Desired experience for revenue specialist includes:
Act as backup for other team members and functions, as needed
Complete ad-hoc system and/or process analysis / documentation as assigned
Coordinate regular meetings with multiple sales & marketing process owners to solicit feedback on forecasted marketing incentive programs
Prepare support for quarterly and annual audits
Assist with SOX initiatives and testing
Ensures accurate and timely charge-capture methodologies are in place and followed for the assigned work unit, and that they are consistent (in terms of standardization) across pertinent areas/facilities as appropriate
Revenue Specialist Examples
1
Revenue Specialist Job Description
Job Description Example
Our company is looking for a revenue specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for revenue specialist
- Provides training to staff engaged in billing data entry and related charge-capture/reconciliation activities to ensure procedures are understood and that charges booked are timely, appropriate, accurate, complete and properly documented
- Collects and reviews documentation
- Assists with reviews and analysis of non-royalty contracts to evaluate and identify potential revenue recognition issues
- Perform daily reconciliations by comparing activities in EBS and iTrack
- Audit existing Property(s) setup to determine if content, pricing and Yield Strategy is appropriate
- Verify and manage rate availability and pricing 15 months into the future following Standard Rate Plan guidelines
- Assists in performing quality control duties
- Performs specialized duties requiring thorough knowledge of customer billing or collections
- These duties include the maintenance and administration of quality assurance programs and the preparation, analysis and maintenance of performance statistics
- Resolves complex billing problems and recommends changes to computer system logic to improve customer service and workflows
Qualifications for revenue specialist
- Analyzes financial statements, quotes deposits, resolves appeals and initiates service denials
- Contacts internal and external customers, states and local officials to provide and receive information
- Prepares and files legal and accounting documents to pursue claims
- Duties may be of a varied nature or dedicated to a specialized function
- Performs special assignments or assists other business areas as necessary
- Interprets existing operational procedures and provides feedback in the development of new operational procedures to accommodate changes in the business environment
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Revenue Specialist Job Description
Job Description Example
Our company is hiring for a revenue specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for revenue specialist
- Coordinates with various departments to ensure accurate data is captured within our systems to maximize revenue and minimize expense exposure
- Responsible for accurate and timely billing of railroad receivables including freight, non-freight, accessorial and payable accruals
- Develop business drivers based monthly and quarterly revenue forecasts for small business segment
- Understand key revenue drivers including unit volumes, ARPU, pricing offers, product mix, channel mix , and develop robust forecasts by geography and by sales channel
- Proactively identify risks and opportunities and escalate appropriately
- Provide insights on financial performance and present recommendations to the leadership team and influence decision making on pricing and marketing
- Develop and deliver impactful executive-level presentations
- Review remittance advices for denials and the appeal process, and finalizing department audit summaries
- Acts as the first point of contact at the hospital for issues with claims reported by biller (holds)
- Examine medical records to ensure that patient bills are correct and making sure that insurance claims comply with government regulations
Qualifications for revenue specialist
- Experience conducting financial analysis - Preferred
- Experience demonstrating a general knowledge of techniques for soliciting and gathering information – Preferred
- Experience working in an internal and/or external audit capacity - Preferred
- Must possess strong organizational skills, be detailed oriented and a self-starter
- Must be analytical and able to perform research
- Ability to manage multiple tasks under restricted time elements
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Revenue Specialist Job Description
Job Description Example
Our company is growing rapidly and is hiring for a revenue specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for revenue specialist
- Coordinates, finalizes and defends patient account audits, reviews documentation for lost charges, has demonstrated ability to write compelling and successful appeal letters
- Compare clinical and financial records to ensure that the documentation provided supports the patient charges listed
- Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care
- Collaborate with multiple departments to prevent vulnerabilities
- Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly
- Share ideas that offer process improvements and train others team members, accordingly
- Will conduct, coordinate, and notify medical records of external audits requested by outside agencies
- Attendance requirements are based on your current role and status of position (FT, PT or PRN)
- Analyzes weekly charge reconciliation reports in order to verify that departments have captured all charges, and compile findings in departmental charge capture performance reports
- Identifies any charge trends and utilizes this information to determine quarterly focused reviews of specific departments
Qualifications for revenue specialist
- Knowledge of Great Plains Accounting System a plus
- Knowledge of RMI a plus
- Basic knowledge of Accounting Rules/Terminology a plus
- Some college and relevant work experience and/or training preferred
- Bachelor’s degree in Business or related field or 10 years related experience
- Three years in Health Information Management or related HCPCS/CPT environment and/or three years in financial/healthcare reimbursement services
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Revenue Specialist Job Description
Job Description Example
Our growing company is looking for a revenue specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for revenue specialist
- Coordinates with the Medical Auditor to review one department's chart documentation every two weeks to verify that the medical record documentation supports the charges billed, prepare a summary report of findings, and share with departmental leadership
- Coordinates with Medical Auditor to review accounts comparing the medical record and itemized bill to identify charging and billing weakness in the system
- Coordinates with CDM Coordinator regarding Medicare and other regulatory updates in order to educate departments and update CDM accordingly on a quarterly basis
- Works with PFS (Denials, Billing and 3rd Party) to identify issues related to denied charges for hospital services, and coordinates with CDM Coordinator to update CDM accordingly
- Meets with clinical departments, as needed, but at least every six months, to ensure service lines are capturing appropriate revenue
- Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other 3rd party billing rules and coverage through self-directed education and communication to departments
- Perform research and resolution duties associated with all deductions, check payment requests and credit types in a team environment
- Research and resolve competitive rate issues
- Research and resolve inventory issues
- Audit the content, rates, restrictions and other pertinent information for newly activated properties legacy properties on partner sites to ensure all information is accurate and the property is available to book
Qualifications for revenue specialist
- Word processing and spreadsheet applications
- Serve as a liaison to corporate revenue integrity staff related to researching and communicating coding and technical requirements for clinical department’s questions related to services, drugs and supplies
- Acts as a liaison between corporate revenue integrity staff and clinical departments for current initiatives and ongoing CDM maintenance
- Reviews CMS quarterly updates and pertinent program memorandums summarizing for manager and AVP
- Proactively assists clinical department managers in developing processes and procedures to validate timely and appropriate capture of all chargeable line items
- Proactively assist in resolving front end charging issues that have been identified from charge audit and CBO
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Revenue Specialist Job Description
Job Description Example
Our company is hiring for a revenue specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for revenue specialist
- Train and activate new properties re-training properties that might need additional assistance managing their participation in the program
- Develops proposals and forwards to Sales and other Pricing groups to facilitate fulfillment of customer requests
- Understands how bids compares to market rates and competitive situations and reviews costs associated with bid to ensure appropriate profitability guidelines
- Works with contract and legal departments to confirm pricing details on contracts and agreements to ensure accuracy and compliance to policies
- Works with basic direction from analyst and completes necessary analysis to support approval
- Obtains knowledge of pricing systems and tools to accurately track proposals through cycle
- Works with appropriate internal systems to ensure timely and accurate pricing implementation
- Works with Sales to verify correct implementation of accepted proposals
- Follows up on outstanding proposals to determine the status of bids and update appropriate reporting system
- Reviews customer accepted pricing proposals to ensure contract integrity
Qualifications for revenue specialist
- Analyze revenue variances and trends and determine any charging inaccuracies as needed
- Research specific accounts related to billing questions as needed
- Other revenue projects as needed
- Bachelor’s degree in Business, Finance, Engineering or related fields
- 2+ years experience in Planning, Finance, Revenue Management, Analytics or related disciplines
- Ability to simplify large amounts of data for executive-level presentations