Revenue Cycle Specialist
Who You Are
You are looking for a mid-level position and are interested in working with a Nashville-based entrepreneurial firm focused on building and growing transformational companies. You have a strong desire to lend your clinical knowledge, passion for creating training programs, and attention to documentation details to up and coming companies that will make a major impact in healthcare. You thrive in innovative and evolving environments with high rates of change. You are driven by process-improvements. Does this sound like you? If so, we should talk.
Who We Are
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care and we are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.
We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients.
We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
You will collaborate with Director of Revenue Cycle and Coding along with other key stake holders in building out Evergreen’s Revenue Cycle Management processes from the ground up. You will review multiple JV Partner RCM processes and workflows to assess that accurate billing information is entered into the billing systems and is properly submitted to CMS. You will assist in the build and manage the revenue cycle, insurance set-up and process metrics within the new EMR that Evergreen will implement.
Primary functions for the Revenue Cycle Specialist include:
- Assist with the building of the internal RCM department from the ground up, including collaboration with P&Ps, developing optimal workflows, and creating the claims submission and reconciliation processes.
- Subject matter expert supporting the implementation of an EHR for the following functions- insurance set-up/verification, claims creation, claims submission, reconciliation, and billing.
- Navigate the different submission methodologies unique to Medicare Advantage and Fee-for-Service – serve as the subject matter expert related to billing for MA and FFS patients (ICDs, E&Ms, CPTs, etc.)
- Reviews JV Partner and internal RCM activities, identify opportunities for improvements, and participates in continuous quality improvement activities to ensure that accurate billing information is entered into the billing systems and submitted to CMS.
- Create and maintain an audit process to ensure correct and accurate RCM processes are maintained, including correct coding and submitting diagnoses and procedures.
- Ongoing process improvement analysis; and implementation of system improvements including meaningful management reports with suggested action plans.
- Identifies, analyzes, and addresses challenges and/or breakdowns in the revenue cycle process.
- Work with EHR vendors on Electronic Interchange (EDI) issues and system upgrades to maximize practice management system utilization.
- Reconcile submissions data with returned claims data to ensure billing information that is submitted is correctly reflected in the claims data.
- Ensure Billing Department adheres to regulations, company policy, HIPAA, 42CFR, CMS, HRSA, FQHC guidelines and statutes and contract requirements.
How You Qualify
- You reviewed the Who You Are section of this job posting and immediately felt the need to read on. That makes you a match for our innovative culture.
- Proven experience in healthcare billing and knowledge of the billing processes/requirements for health insurance providers (MA) and CMS (FFS).
- Experience in EHR implementation and ability to engage in cognitive participation with project management team.
- Minimum 3-5 years’ experience in Medicare billing, accounts receivable, modifiers, HCPCS, CPT and ICD-10 coding.
- Strong interpersonal and organizational skills.
- You accept that things change quickly in a startup environment and are willing to pivot quickly on priorities.
- Experience in a team-based service environment.
- Ability to work independently and in a relatively unstructured manner.
- Excellent communication skills, you must be bold enough to speak up when something is non-compliant.
How You are Supported
- You will benefit from Evergreen Nephrology’s exceptional total rewards package, including competitive base pay with bonuses, paid time off starting at 4 weeks for full time employees, 12 paid holidays per year, reimbursement for continuing medical education, 401k with match, health, dental, and vision insurance
- Family friendly policies that support paid parental leave and flexible work arrangements.
- As a team member you’ll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career with Evergreen Nephrology
- You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of Evergreen Nephrology’s high-quality, value-based, care model
Evergreen Nephrology is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about your EEO rights as an applicant (Opens in a new window) .
Evergreen Nephrology will not discriminate or retaliate against applicants who inquire about, disclose, or discuss their compensation or that of other applicants. United States Department of Labor. Learn more (Opens in a new window) .