Revenue Cycle Specialist - UCSF Health Medical Foundation

Revenue Cycle Specialist

UCSF Benioff Children’s Physicians (UBCP) is a multispecialty physician foundation, and an associated clinically integrated network. Our primary goal is to foster physician collaboration to deliver the most advanced maternal and pediatric care throughout Northern California and beyond. We are committed to valuing diversity and contributing to an inclusive working environment. We have Pediatric and Adolescent Care, After Hours Care, Ophthalmology, OB-GYN and Maternal-Fetal Medicine clinics located throughout the San Francisco Bay area.

POSITION SUMMARY:

Responsible for varying facets of the revenue cycle processes. These processes can include charge entry, EPIC work queue oversight and correction, claims denials due to non-coding issues, payment posting, refunds and other revenue cycle assistance to the various practices within UBCP. Works collaboratively with Revenue Cycle colleagues to ensure provision of work products that meet quality and quantity expectations established by the organization.

Responsibilities:

1. Comprehensive claims management to include evaluation of payments, denials, registration, appeals and research as appropriate for all UBCP practices.

2. Conducts appropriate follow through when insurance coverage is not eligible.

3. Review, document and execute patient refunds with adjustment posting follow through.

4. Addresses all correspondence assigned within seven days of receipt.

5. Customer service and pre-collection of self-pay account balances as assigned

6. Help to identify trends and provide possible solutions to reduce rejected and/or unpaid claims.

7. Provide direct communication with practices as necessary to complete job duties.

8. Documents in a clear manner to support all changes and process improvement.

9. Quality responsibilities:

i. Maintain 95% accuracy of job duties.

ii. Stops when uncertain and takes the time to resolve situations.

iii. Shares and seeks knowledge and provides feedback to others.

iv. Partners with all team members to achieve goals.

Essential Functions:

A. Productivity/Efficiency:

• Works collaboratively with Revenue Cycle colleagues to ensure provision of work

products that meets quality and quantity expectations.

B. Critical and Analytical Thinking:

• Possess the ability to analyze situations and strategize solutions.

C. Technical Skills:

• Strong computer skills especially in EPIC, Microsoft Office tools also required.

D. Communication (Oral and Written):

• Excellent verbal and written communication skills.

• Ability to demonstrate diplomacy in communication and use conflict resolution

techniques.

E. Professional Accountability:

• Engages in teamwork and collegial collaboration among all team members.

• Maintains positive working relationships with UBCP colleagues, and others.

• Ensures work product meets defined quality, quantity and timeliness expectations.

F. Quality and Service:

• Monitors and addresses potential risk management and quality issues in a timely

manner.

• Addresses quality and quantity requirements in an effective and timely manner.

• Maintains standards of service, productivity, safety, and security.

• Ensure Electronic Health Record (E.H.R.) optimization within the organization.

• Participate in initiatives to achieve performance on quality metrics set forth by the

organization.

G. Other Job Functions:

• Performs other duties as assigned.

POSITION REQUIREMENTS:

Skills:

• Computer (Explorer, Excel, Word, Outlook, EPIC (or other EHR software).

Ability:

• Multi-task and work independently.

• Good communication skills both verbal and written.

Education:

• High School/GED

Knowledge:

• Knowledge of insurance billing and compliance with a high level of problem solving

skills.

• Medical terminology, rules, and regulations relating to the Revenue Cycle.

• Understanding of managed care contracts, insurance and credentialing compliance

Experience:

• 5+ years of healthcare accounts receivable experience with expertise in un-adjudicated

claim management, appeals and pre-collections.

ADDITIONAL INFORMATION

A. Physical Requirements

• Must be able to lift 20 pounds.

• Must be able to walk, stand, or sit for long periods of time.

B. Working Relationships/Contacts:

• Initiates and maintains communication with Manager and colleagues on critical issues.

• Initiates and maintains effective working relationships with UBCP colleagues and other people with whom the incumbent must interact to perform their responsibilities.

• Respects and is sensitive to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, teamwork, and demonstrates respect for others.

Equal Employment Opportunity
UCSF Benioff Children’s Physicians (UBCP)is an equal opportunity employer. In accordance with applicable law, we prohibit discrimination against any applicant or employee based on any legally-recognized basis, including, but not limited to: veteran status, uniformed service member status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy (including childbirth, lactation and related medical conditions), national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other consideration protected by federal, state or local law. Our commitment to equal opportunity employment applies to all persons involved in our operations and prohibits unlawful discrimination by any employee, including supervisors and co-workers.