Sr Revenue Cycle Specialist

At Stony Brook Medicine, the Senior Revenue Cycle Specialist will act as operational lead in the Revenue Recovery and Retention Unit of the hospital’s business office working to analyze, track and pursue the payment of Managed Care under-paid and denied accounts receivable. Successful candidates will have a bachelor’s degree and three years’ healthcare revenue cycle experience or in lieu of degree 5 plus years’ experience in an Acute Care Hospital Revenue Cycle or Patient Accounting Department resolving hospital Managed Care payment variances and denials. Experience with a Hospital Contract Management system such as Cerner, Optum or Epic is strongly preferred.

Job Responsibilities:

• Lead Payer Joint Operating Calls (JOC).
• Analyze payment variances; track and pursue under-paid and denied accounts. 
• Liaise with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials.
• Track and trend denials, systemic underpayments. Maintain JOC Trackers.
• Analyze new contracts and work with Contract Management system support to configure contract rates and terms.
• QA all Contract Management system changes including encounter qualifiers and payment rates and methodologies.
• Develop staff work listing logic/strategy and claims resolution work flows.
• Educate new staff regarding Managed Care Contracts, CM System and Denials and Appeals process.
• Assist in maintaining and creating payer report cards, claims tracking and management reporting as requested.
• Special projects, as assigned. 

Required Qualifications:

• Bachelor’s degree and three years’ healthcare revenue cycle experience, 
  or in lieu of degree, 5 years or more of Healthcare Revenue Cycle experience resolving hospital Managed Care payment variances and denials.
• Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies.
• Expert knowledge of third party reimbursement methodology and associated healthcare claim drivers.
• Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i).
• Experience working with CPT/HCPCs and ICD-10 codes.
• Experience working with Cerner Invision Patient Accounting.
• Proficiency in MS Office Suite, including: Excel, Word.
• Excellent written and verbal communication skills.

Preferred Qualifications:

• Experience working within Cerner Contract Management, Epic or equivalent including experience in validating the configuration and build of contracts.
• Experience building contracts and modeling revenue in a Hospital Contract Management System.
• Medical Coding Certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA).
• Proficiency with MS Access, Visio and/or PowerPoint.
• Knowledge of SQL or Database Queries.
• Experience reporting from healthcare decision support, patient accounting, contract management and/or claims scrubber systems.
• Proficiency with SAP Business Objects / Crystal Reports. 
• Proficiency with visualization software (Tableau, MS Power BI, etc.).

Please Note: Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.

Special Notes:   Resume/CV should be included with the online application.

Posting Overview:  This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date). 

If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.

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• Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
• All Hospital positions may be subject to changes in pass days and shifts as necessary. 
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair. 
• This function/position may be designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities. 

Prior to start date, the selected candidate must meet the following requirements: 

• Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4-panel drug screen*
• Meet Regulatory Requirements for pre-employment screenings.
• Provide a copy of any required New York State license(s)/certificate(s). 

Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer. 

*The hiring department will be responsible for any fee incurred for examination.

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Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.

If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280. 

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Visit our WHY WORK HERE page to learn about the total rewards we offer.

Stony Brook University Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.

Anticipated Pay Range:

The salary range (or hiring range) for this position is $77,286 - $94,211 / year.

The above salary range represents SBUH’s good faith and reasonable estimate of the range of possible compensation at the time of posting.  The specific salary offer will be based on the candidate’s validated years of comparable experience. Any efforts to inflate or misrepresent experience are grounds for disqualification from the application process or termination of employment if hired. 

Some positions offer annual supplemental pay such as:

• Location pay for UUP, CSEA & PEF full-time positions ($4,000).

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Your total compensation goes beyond the number in your paycheck. SBUH provides generous leave, health plans, and a state pension that add to your bottom line.