Revenue Cycle Specialist

• Clinical Services - Medical Clinic
• Indianapolis, IN, USA
• $55,000
• Salary
• Full Time
• Full Benefits Package

Revenue Cycle Specialist

 Department of Business & Health Operations

Damien Center Values

Dignity-Collaboration-Accountability-Equity-Quality-Innovation

Founded in 1987, Damien Center is Indiana's oldest and largest AIDS service organization (ASO) and serves more than 8000 individuals living with or at risk for HIV through a comprehensive, innovative approach to care and prevention. Our purpose is to be a trusted partner in providing services, education and advocacy for all people living with or at risk for HIV and any person seeking a safe and welcoming home for care. Our services include care coordination, clinical and pharmacy services, mental health, housing, and nutrition.

Position Summary:

The Revenue Cycle Specialist is a multidisciplinary position that coordinates the health center's medical and pharmacy revenue cycles for all specialty products. The Specialist will work closely with Medical, Pharmacy, and Patient Access teams coordinating treatment plans, ensuring clean claim submission, focusing efforts to maximize reimbursement and reducing Accounts Receivable (AR).

Duties and Responsibilities:

This job description describes the general nature and level of work performed by employees assigned to this position. It should not be construed as an exhaustive list of all required duties, responsibilities, and skills.

• Facilitates medical and pharmacy revenue cycle protocols for all current and future specialty products, including but not limited to Oral Pharmaceutical, long-acting Injectable Antiretroviral Therapy (LAI-ART), Long-Acting Reversable Contraceptives (LARC), Therapeutic Injections, and Medicare Part B-covered supplies and medications.
• Initiates and maintains prior authorizations for both medical and pharmacy benefit for all specialty products.
• Initiates and maintains enrollment in manufacturer patient savings/assistance programs and advocacy foundations that provide financial support.
• Reviews all claims containing specialty products to ensure clean claim submission.
• Maintains current knowledge of billing policies and guidelines for all specialty products.
• Coordinates with 340B Department to ensure compliance for all clinic-administered drugs.
• Reviews month-end Buy-and-Bill statements ensuring that appropriate billing occurred.
• Coordinates with Clinical Pharmacy department to ensure that treatment authorization is re-validated when patient insurances change.
• Communicates with patients if there are any billing or financial related concerns to the treatment plan.
• Posts payments from third-party payors.
• Investigates denials and facilitates appeals for both medical and pharmacy service lines.
• Assists the Revenue Cycle Manager with monitoring and analysis of accounts receivable (AR) for both medical and pharmacy service lines.
• Assists with reviewing and updating related policies and procedures.
• Attends all department and committee meetings as assigned.
• Performs special assignments and other work, on an as-needed basis.

Education and/or Experience

• High School Diploma or equivalent required.
• Certified Medical Assistant (CMA) OR Licensed Pharmacy Technician (LPT) required.
• Minimum 3-5 years of relevant experience in medical and/or pharmacy billing required.
• Certification required or obtained within 6 months of hiring: CPC (AAPC) or CCS (AHIMA). 
• Experience with professional (CMS-1500) and institution (CMS-1450/UB-04) claim billing preferred.
• Experience with Medicare Part B Pharmacy Supplier billing preferred.
• Experience with eClinicalWorks and/or Pioneer Rx. strongly preferred.
• Bachelor's degree strongly preferred but not required.
• Bilingual in English/Spanish highly desired.

*Work or lived experience may substitute for education requirements on a case-by-case basis.

Knowledge, Skills, and Abilities:

Possess superior organizational and administrative skills. Excellent interpersonal and communication abilities. Excellent computer skills in a Microsoft Windows environment. Ability to work independently and achieve high standards of productivity, achieving deadlines and with superior product results. Strong calendaring, organizational, and document management skills required. Proactive approach to solving problems and communicating to leadership. Knowledge of office management systems, procedures, and office equipment required. Excellent time management skills and ability to prioritize work.

Qualifications

To perform this job successfully, an individual must be able to perform each essential job function satisfactorily. The requirements listed are representative of the basic knowledge, skills, and/or abilities required.  Reasonable accommodations may be made for individuals with disabilities to perform the essential functions.  The individual in this role must display the highest level of integrity and confidentiality. The individual should have effective communication skills, attention to detail and organization, and flexibility and adaptability. The individual will also maintain knowledge of trends in their area of responsibility.

Physical Demands: 

The physical demands described here are general representations of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made for individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit, reach with hands and arms, talk, and hear. The employee frequently is required to use hands to touch and handle objects. The employee frequently stands or walks.
• The employee must occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment: 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made for individuals with disabilities to perform the essential functions. Remote work is on a case-by-case basis and must be approved by the supervisor.

• Office setting, with sustained use of a computer.
• The noise level in the work environment is minimal to moderate.
• Individuals should maintain personal and professional competency and work to create an environment of courtesy, respect, inclusion, and positivity in all interactions both internal and external to the organization.

• FLSA Status: Salary, Full-time, Exempt               
• Leader: Revenue Cycle Manager
• Salary: $55,000

• Benefits: 
• 150 hours of PTO in the first year followed by 195 hours per year moving forward.

• 12 paid holidays
•  Medical coverage options include a PPO plan or a HDHP.
• Dental & Vision plans
• Health Saving Account or Flexible Spending Account
• Dependent Care Flexible Spending Account
• Employee Assistance Program
• 403b Retirement Account with 5% matching and 100% vesting after 90 days
• Life Insurance @ 2 times the annual salary
• Voluntary Life Insurance Plan including spouse and child coverage options
• Short- & Long-Term Disability Plans
• Premium Subscription to the CALM APP which assists with anxiety, stress & other mental health challenges
• Professional Development Opportunities
• Tuition Assistance
• Annual performance review that includes an annual performance-based salary increase

Protecting our team members, clients, volunteers, and community partners is an integral part of how we ensure our continued work with the clients we serve.  As a condition of employment, Damien Center requires team members to be vaccinated against influenza and receive a tuberculosis skin test (or chest x-ray) annually, and to be vaccinated against COVID-19 (including all boosters), barring an approved religious or medical exemption.   

Damien Center is an Equal Opportunity Employer

Damien Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, family status, ethnicity, national origin, age, disability, marital status, amnesty, status as a covered veteran, other legally protected status, or genetic (including family medical history) information.

Damien Center complies with applicable federal laws and with all state and local laws governing non-discrimination in employment in every location in which Damien Center has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Please apply at www.damien.org/job-opportunities

This position description does not constitute a contract of employment or guarantee of any terms or conditions of employment.  Damien Center employees are employed on an at-will basis. Nothing in this position description restricts Damien Center's right to assign or reassign duties and responsibilities to this position at any time.