Business Process Specialist researches, analyzes, and recommends changes to an organization's business processes to improve operational efficiencies, quality, service, and profitability. Collects and studies operational and performance data to identify trends and opportunities for improvement. Being a Business Process Specialist develops process documentation and project plans. Creates flowcharts, process maps, and diagrams. Additionally, Business Process Specialist supports cross-functional activities and working sessions during projects' design and implementation phases. Designs and prepares documentation, training materials, and communications supporting new processes. May deliver training to impacted business units. Requires a bachelor's degree. Typically reports to a manager. The Business Process Specialist work is highly independent. May assume a team lead role for the work group. A specialist on complex technical and business matters. To be a Business Process Specialist typically requires 7+ years of related experience. (Copyright 2024 Salary.com)
The responsibility of the Revenue Cycle Claims Specialist is to maintains current knowledge of insurance carriers’ rules, regulations, and contracts; acts as a liaison for patients with the insurance carrier for internal/external customers; and is responsible for posting payments, adjustments, status, and reason codes. Contracts are reviewed for accuracy of payment with direct communication with payer provider reps. Analyze and test new system modules and upgrades. Confirmed and maintains mandated requirements for provider rosters.
1. Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlined in the Service and Behavioral Standards document. To this end, employees will be expected to read, have familiarity with, and embrace the principles contained within.
2. Research and resolve claims based on assignment, which could include contacting payers via phone or website, contacting practices, working across departments, writing appeals, and facilitating their submission, and all other activities that lead to the successful adjudication of eligible claims.
3. Working with Practice Management and co-source model to keep files up to date and identify and seek support.
4. Monitor and execute work on assigned worklists, reports, projects, or team goals.
5. Meet productivity standards as set by management.
6. Demonstrate knowledge and understanding of insurance billing procedures as evidenced by the identification of root-causes of claim issues and proposed resolutions to ensure timely and appropriate payment.
7. Educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers, and others as necessary to ensure accurate processes.
8. Reporting and Research: Identify issues and/or trends and provide suggestions for resolution to management, including payer, system, or escalated account issues. Evaluate carrier and departmental information and determine data to be included in system tables.
1. Two (2) or more years of successful experience within medical billing office
2. Two (2) or more years of computer skills and PC experience, including word and Excel.
3. One (1) or more years of customer service experience
1. Intermediate computer skills, including MS Word and Excel
2. Knowledge of medical terminology, CPT, ICD-9 and ICD-10 coding
3. Knowledge of finance/accounting, including insurance carrier billing
4. Excellent oral and written communication skills
5. Ability to work with difficult/upset people.
6. Ability to collaborate well with providers and other staff.
7. Ability to work on multiple tasks simultaneously in a busy, demanding environment while maintaining quality of work.
0 Business Process Specialist jobs found in Salem, OR area