Sr Analyst,Revenue Cycle

Company: Oak Street Health

Title: Sr. Associate, Revenue Cycle

Company Description

The mission of Oak Street Health is to rebuild healthcare as it should be. 

We are a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare.

The Oak Street model integrates outstanding clinical expertise, technology, and teamwork to deliver improved care quality and cost savings. These cost savings are then reinvested into care in our communities, creating a virtuous cycle of improving community health. 

We are a national organization serving over 100,000 patients and we are growing rapidly. We are a diverse team of care providers, service team members, technologists, community outreach experts, business professionals, and more -- all dedicated to our Oaky Values and motivated by our mission. We're looking forward to getting to know you!

For more information, visit www.oakstreethealth.com.

Role Description:

The Sr Revenue Cycle Associate role will be involved in the company's day-to-day revenue cycle management and accounts receivable operations to ensure timely and appropriate submission of health care claims and subsequent payment for services rendered. This role will also coach/mentor a team of peers to achieve established goals. 

Core Responsibilities:

• Possess strong critical thinking and problem-solving skills to work through complex payer issues within claim denials, underpayments and/or missing payments

• Work with billing vendor to monitor timely claim submissions and posting payments

• Follow up with insurance companies on claim denials and submission of claim corrections

• Experience using available tools (websites, electronic medical records, and payer systems) to efficiently complete eligibility lookups, claim inquiries, create/maintain admin and user accounts for new and terminated employees 

• Contact payers to obtain clarification and/or details regarding incorrect payment/denials

• Maintain working knowledge of company policies for collections, adjustments and write-offs

• Effectively work edits from a claim scrubbing software (NCCI, Custom payer rules etc.)

• Analyze data from billing vendor and/or business intelligent department to identify trends and create reports for management

• Extract details from medical records to substantiate billing/coding changes

• Serve as a liaison between administrative and clinical staff within our clinics to resolve billing questions

• Communicate effectively using helpdesk ticketing system to research clinic inquiries regarding patient statements and/or account balances

• Identify process improvements and escalate to management for further review

• Create documentation for training peers on new processes 

• Monitor metrics and productivity to ensure team is meeting established standards

• Ensure practice management software is setup accurately for all new and existing locations 

• Accurately complete assignments in a timely manner

• Adaptable to changing procedures and a growing environment

• Other duties, as assigned

What are we looking for?

We're looking for motivated individuals with following qualifications:

• The ideal candidate must know medical terminology, have experience in health care accounts receivable follow-up, and have a thorough understanding of the health claim revenue cycle workflow process

• Education minimum of Associates degree, Bachelor's degree preferred

• Knowledge of reading and interpreting insurance Explanation of Benefits (EOB) statements

• At least 2 years of working on coding denials, and understanding of NCCI edits is preferred

• Solid understanding of insurance guidelines and principles, including COB, HIPAA, CPT, ICD-10, Medicare and managed care plans

• Proficiency in reading proper insurance plan and policy# from insurance ID cards

• Time management skills and the ability to meet deadlines is imperative

• Excel/Google Sheets experienced preferred

• CPC credential is a plus

• Database query or business analyst experience a plus

• US work authorization

• Someone who embodies being "Oaky"

What does being "Oaky" look like?

• Radiating positive energy

• Assuming good intentions

• Creating an unmatched patient experience

• Driving clinical excellence

• Taking ownership and delivering results

• Being scrappy

Why Oak Street?

Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:

• Collaborative and energetic culture

• Fast-paced and innovative environment

• Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/careers.