Scope of Position

The Revenue Cycle Clinical Support Office (RCCS) is an area within Access and Revenue Cycle Management Shared Services responsible for managing the Health System’s Denials, UH/Ross Clinical Pre-certification, Case reviews, In-Patient claims, Medicare A to B Billing, and supporting Utilization Management to ensure requirements are met. RCCS is also responsible for responding to Government, Commercial and Internal audits. RCCS provides extensive reporting to Senior Leadership on these areas. The Health System includes all facility billing for University Hospital, Ross Heart Hospital, University Hospital East, The Arthur G. James Cancer Hospital, OSU Harding Hospital, and Dodd Hall Rehabilitation. RCCS interprets payer requirements and develops processes to obtain clinical precertification and aggressive appeal arguments in collaboration with physicians. Claims are reviewed and edited to ensure accurate billing. Information Technology and Reporting are leveraged to efficiently manage the extensive volume of claim activity to ensure timely processing of claims.

RCCS is integral to the support of a successful/health and compliant revenue cycle. It is responsible for bringing in cash to support the financial bottom line, keeping days in Accounts Receivable low, maintaining efficient/effective operations, and supporting patient friendly experiences.

The Revenue Cycle Services Specialist LEAD (RCSSL) provides administrative and analytical support to the Director and Management team in RCCS through oversight of Revenue Cycle Services Specialists (RCSS) and Revenue Cycle Services Coordinators (RCSCs)

The LEAD provides expert knowledge and advanced understanding of concepts to manage a wide variety of projects while overseeing staff and their workloads. Develops new practices, processes, metrics and models. Responsible for resolving issues related to authorizations, utilization review requirements, billing, and compliance within the revenue cycle for OSU Health System through using quantitative and qualitative analysis techniques. The RCSSL supports OSU Health System in meeting objectives of a successful and compliant revenue cycle through increasing cash on hand, lowering AR days, and lowering rejections/denials.

Position Summary

The Resource Planning Analyst Lead (RCSSL) is responsible for a wide variety of functions that include conducting quantitative and qualitative analyses, strategic planning, policy/process development, quality improvement, developing/monitoring metrics and supporting RCCS Management and staff.

The RCSSL independently determines methods for completion of projects and provides guidance to staff.

The RCSSLPAL is the first line contact for the staff they oversee and has excellent communication skills and is the team expert in analyzing and resolving account issues. Works/leads complex projects. Understands payers’ requirements and works to resolve issues. Performs This second-level reviews for denials to determine root cause and formulate an appeal strategy. Writes and submits appeals. Responsible for departmental communication and process improvement. Competent in all available systems where revenue cycle information is held accessing governmental and commercial websites.

Minimum Qualifications

For Hire Required:

• Minimum of a bachelor degree in healthcare administration or appropriate closely related field.
• Experience with Excel, Access, OneNote and PowerPoint
• Ability to synthesize information and concisely communicate either verbally or in writing is essential.
• Ability to work well under pressure.
• Ability to demonstrate independence, self-initiative, thoroughness, and attention to detail.

For Hire Preferred:

• Knowledge of all aspects of the revenue cycle (scheduling, patient flow through the system for inpatient and outpatient, patient placement, charge entry, billing).
• Operational knowledge of the primary revenue cycle systems (EPIC) along with systems processes and design.
• Knowledge of RCCS CSC Workflows.