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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:

• Maintain detailed knowledge of revenue cycle functions and metrics. Work accounts receivables to ensure timely payments from insurance and/or patients. Initiates claims submissions, performs review of accounts, ensures work performed is accurate and complete. Documents contact with patients, guarantors, insurance companies and others using the appropriate methods. Identify trends, conduct follow-up, and perform root cause analysis on unpaid and underpaid accounts.
  (50%)
• Trains staff, 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.
  (20%)
• 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.
  (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

• 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

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays

• 100% paid parental leave up to 6 weeks

• Immediate eligibility for retirement plans with employer contribution up to 9.5%

• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.

• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center

• Free RTD EcoPass (public transportation)

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

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

About Denver Health

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, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado’s primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

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

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.

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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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