Shire Jobs

At Stony Brook Medicine, the Senior Revenue Cycle Specialist will act as an operational leader in the Hospitals Business Office to analyze, track, and pursue the payment of under-paid and denied accounts receivable. Successful candidates will have a bachelors degree and three years healthcare revenue cycle experience or in lieu of degree 5 plus years experience in an Acute Care Hospital Revenue Cycle or Patient Accounting Department resolving hospital Managed Care payment variances and/or denials. Job Responsibilities may include the following, but are not limited to: Develops staff work listing logic, strategy and claims resolution work flows. Educates and trains new staff regarding departmental / unit policy and procedure, including: Managed Care Contracts. Monitors work queues and staff productivity to ensure work volumes and staffing are aligned. Audits staff work; provide education on best practice. Supervises junior staff. Completes employee performance programs and evaluations, scheduling and timesheets. Analyzes and identifies claim payment issues, patterns, and root cause; tracks and pursues un-timely, under-paid and denied accounts. Collaborates on denials prevention initiatives. Liaises with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials. Collaborates with the Managed Care Department, HIM and Patient Accounting leadership to address payment issues and resolve at risk/high dollar accounts. Analyzes new contracts and works with Contract Management system support to trouble-shoot contract rates and terms. Participates in Joint Operating Calls (JOC) with insurance payers. Monitors medical record request, correspondence distribution and scanning processes, volume, and trends. Assists in maintaining and creating payer report cards, claims tracking and management reporting as requested. Assists management reporting and special projects as requested.