Note: The job is a remote job and is open to candidates in USA. Cottage Health is a leading acute care hospital system serving central coast communities with a focus on patient care, innovation, medical research, and education. Pacific Diagnostic Laboratories is seeking a PDL Revenue Operations Analyst to oversee denials management, appeals, self-pay inventory, claims write-offs, payer policy changes, accounts receivable aging, and insurance eligibility trends. The role also communicates activity to stakeholders, supports departmental goals, ensures regulatory compliance, and assists with recruitment, training, retention, and work allocation.
Responsibilities
- Responsible for the overall day-to-day operations of denials management, appeals, self-pay inventory, claims write-offs, client edits, client portal usage, payer policy changes, AR aging across all payer classes, insurance eligibility and insurance discovery trends
- Actively oversees, maintains, and communicates denials and appeals activity to clients and internal stakeholders
- Provides guidance and direction to the team to ensure the department maintains or exceeds goals including total AR collections, credit balances, # of and amount of edits and denials, identifies emerging trends in claims payments and assesses expected vs actual reimbursement
- Ensures all activities are performed in compliance with Cottage Health (CH) and PDL policies, procedures, and Federal and State regulations
- Assists in recruitment, retention, training and work allocation
Skills
- * Required: Bachelor's degree or equivalent Lab RCM work experience of 6 years
- * Required: Must be able to demonstrate an understanding of ICD-10 coding for Lab CPT's, working payer denials and appeal processes
- Expertise in healthcare insurance eligibility, verification and claims filing procedures
- Expertise in utilizing software applications to maximize automation and efficiency in a business office setting
- Proficient in Microsoft Office suite, with an emphasis on Excel and PowerPoint
- Able to analyze data to identify trends and opportunities for process improvement
- * Required: Five years LAB RCM experience, preferably in a multi-facility environment including three (3) years of progressive responsibility in healthcare revenue cycle
- Experience working with legal consent policy and procedures and payer contracting and policies
- Knowledge of medical terminology
- * Preferred: MS-Office 365
- * Preferred: Minimum if five (5) years related work experience
Benefits
- Eligible employees may also receive additional forms of compensation, including shift differentials, on-call pay, incentive pay, and bonus opportunities, where applicable.
- Manager and above positions may participate in Cottage Health’s annual management incentive program.
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