Transfer DRG Revenue Review Specialist

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

• Communicate with payer and facility representatives via phone & provider portals to verify patient’s discharge disposition.
• Clearly and concisely document communications with payer and facility representatives for internal team review.
• Verify claims with updated coding have been issued or route claims to appropriate work queue.
• Analyze and ascertain pertinent information from multiple sources (e.g., hospital systems, medical records, claims) to identify facility information as applicable.
• Manage multiple internal projects while adhering to deadlines and weekly goals.
• Other duties as assigned.

MINIMUM QUALIFICATIONS & REQUIREMENTS:

• Associate’s Degree or one year of relevant work experience preferred.
• Experience reviewing hospital claims, payor contracts, and general revenue cycle experience preferred.
• Professional experience communicating with insurance companies verbally.
• Ability to effectively navigate Hospital’s optical storage and patient accounting systems.
• Strong verbal and written communication skills.
• Ability to conduct research via multiple channels (internet, client and payer systems, and internal resources.
• Must be able to multi-task and remain diligent with workload/multi-project while maintaining strong attention to detail.
• Intermediate computer skills, including MS Office Access, Excel, Word (such as ability to use formulas and functions, create pivot tables, mail merge, etc.).
• Independent work ethic while also collaborating with a team to achieve goals.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.