Revenue Cycle Specialist

The Revenue Cycle Specialist acts as a liaison between affiliate health centers and contracted revenue cycle contractors and acts as a direct support to clinic managers and staff, while supporting patients financial needs.

Planned Parenthood Arizona (PPAZ) is Arizona’s largest reproductive health care provider, serving over 34,000 patients every year. PPAZ also works to educate communities, lead research directly impacting Arizonans; and advocate for access to health care, resources, and democracy regardless of your race, gender, class, orientation, identity, or status.

Given that Arizona could ban abortion with a court decision on any day, working with impacted communities and activated supporters is a keystone of PPAZ’s organizing philosophy: lived experience and the stories that go along with those experiences are invaluable currency when working to educate decision-makers on the impacts of public policy or court decisions like Dobbs that overturned Roe.

GENERAL PRIORITIES

• Adheres to affiliate goals and policies on professionalism and provides excellent internal and external customer service.
• Participates in the affiliate’s efforts to achieve the following established revenue cycle goals: (i) days in A/R is 30-45 days; (ii) Net Self-Pay Collection Rate is 95%; (iii) percentage of A/R greater than 120 days is 15% or less; (iv) Rejection Rate is less than 5%; (v) Credit Balance of A/R is less than 2% of total A/R resolved within 60 days; and (vi) Charge Lag is no more than 1 day from the service date.
• Reviews and makes corrections to rejected claims for invalid CPT, DX, missing modifiers, COB, and any other required interventions and resubmits corrected claims.
• Performs daily/monthly audit of self-pay encounters to ensure integrity of patient accounts and sends emails to health centers, as appropriate.
• Ensures timely follow-up of open accounts receivable for assigned accounts in accordance with the affiliate’s established revenue cycle procedures and goals.
• Reviews Electronic Remittance Advices and Paper Explanation of Benefits upon receipt to confirm that payment was made as expected and to immediately identify the need for follow-up with the payer or to process a credit adjustment/refund request.
• Reviews credit balances of assigned accounts and makes appropriate adjustments, transfers or refund requests and documents actions in EPIC/NextGen.  Uses the Credit balance report in accordance with the affiliate’s established revenue cycle procedures and processes refunds for accounting team to issue.
• Managers any returned checks. Works closely with accounting team to make appropriate adjustments to accounts whose checks were returned.
• Works with the revenue cycle team and manager to identify revenue generation and reimbursement opportunities.
• Works closely with clinics and front office staff to take action on any trends identified that involve operations workflows.
• Training of clinic staff on billing and collections processes within EMR system. Trains new collections processes or changes in workflows
• Provides financial counseling to patients and clinic staff to assist with patient care.
• Justice Funds: run reports and reviews accuracy and status of patients receiving justice funds. Uploads JF reports monthly.
• Manages JIRA tickets affiliated with revenue cycle, ensuring they are submitted timely, include pertinent information and are followed up on.
• Works with CHN to ensure patients’ insurance coverage is verified for same day, walk in, and scheduled patients using electronic, web-based and phone contact tools.  Completes the appropriate Insurance Verification Form and documents eligibility and level of coverage as well as identifies the expected patient responsibility.  Provides near immediate responses to the Health Centers for walk-in patients.
• Shares and provides feedback on build/workflow configuration and requesting changes for EMR configuration.
• Works affiliate work queues and communicates to manager and CHN any work queue functionality issues.
• Maintains confidentiality of all department, patient and billing matters and adheres to all HIPAA guidelines/regulations.

EDUCATION AND/OR EXPERIENCE

• A High School diploma or General Education Degree (GED), required.
• At least two years of revenue cycle experience in a hospital or medical practice setting is required.
• Previous experience using ICD-10 Medical Coding and Current Procedural Terminology (CPT) is required. Formal coding training is desirable.
• Solid foundation in medical terminology is required.
• Two years’ experience in performing insurance verification via payer portals and phone calls to insurance companies with the ability to accurately calculate patient responsibilities that should be collected at the time of service.
• Previous experience using Epic EMR software experience is required, including ability to create reports and manipulate data, including excel exports capabilities. 
• Ability to navigate and understanding documentation in Epic EMR is required.
• Solid understanding of insurance company explanation of benefits is required.
• Basic Excel, MS Word with Windows based computer experience skills required.
• Good telephone and written communication skills are required.

How to Apply

When applying please check your junk/SPAM folder for the invite for a phone screening.

This job requires a background check once a job offer is extended to the final candidate. PPAZ does not discriminate in employment and understands the many barriers candidates may face when applying to jobs. One of those barriers being the current criminal justice system and its effect on background checks. We understand that these barriers more often negatively impact BIPOC, and as an organization, we are working to eliminate those barriers.

A conviction is not an absolute bar to employment. Factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered in all employment decisions. PPAZ encourages all interested parties to apply for this position.

Planned Parenthood Arizona is an Equal Opportunity Employer.