The Revenue Optimization Specialist is responsible for maximizing revenue from designated payers. This involves creating processes and tools to ensure timely, accurate billing, collections, issue resolution, and payment processing for the assigned payer(s). The Revenue Optimization Specialist focuses on analyzing and improving hospital revenue cycle processes, with an emphasis on collections, revenue optimization, and data-driven decision-making. This role works closely with the business office, coding and leadership to enhance reimbursements and operational efficiency.

KEY RESPONSIBILITIES

Collections Analysis:

• Monitor and analyze collections data to identify trends, patterns, and areas of concern.
• Collaborate with the collections team to develop strategies to enhance payment timeliness and reduce aged accounts.
• Provide recommendations to improve the hospital’s accounts receivable processes, including identifying opportunities to minimize denials and underpayments.
• Use data analytics to perform root cause analysis of revenue cycle issues and recommend corrective actions

Collections and Appeals:

• Contact payors to resolve outstanding claims and expedite payments. Track and submit appeals for denied claims with necessary documentation
• Investigate reasons for claim denials or underpayments and collaborate with payors to rectify issues.
• Maintain detailed records of payor interactions, including call logs, emails, and payment outcomes, for reporting and audit purposes.

Process Improvement:

• Work closely with the business office team to implement process improvements based on data analysis and findings.
• Assist in identifying and correcting workflow inefficiencies that may impact the hospital’s ability to collect revenue.
• Collaborate with finance, billing, coding, and clinical departments to improve revenue integrity and ensure compliance with hospital policies and payer regulations
• Assist in staff training on billing and collection procedures to ensure adherence to optimized processes

MINIMUM EDUCATION

Bachelor’s degree in Finance, Healthcare Admin, Business, or a related field is required.

MINIMUM WORK EXPERIENCE

None.

REQUIRED LICENSES/CERTIFICATIONS

None.

Preferred Qualifications:

Advanced excel skills.  Tablou and PowerBI would be a bonus.

ABOUT OAKBEND

OakBend Medical Center is an independent hospital providing exceptional and compassionate care to patients and the community since 1950. The OakBend family consists of outstanding team members caring for the community at three hospitals and many specialty centers. OakBend’s services and programs include its signature No Wait ER, an advanced trauma center, certified stroke program, hospital air ambulance services and a hospital-based skilled nursing facility. We remain committed to providing a rewarding environment to our team members, to providing necessary services to the community and to developing the best methods to care for our patients, ensuring a healthy future for generations.