- Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.
Job Summary
- We are seeking a detail-oriented and experienced individual to join our team as a Revenue Cycle Process Audit Specialist in US healthcare. In this role, you will be responsible for conducting audits and reviews of various revenue cycle processes to ensure accuracy, efficiency, and compliance with healthcare regulations and billing guidelines. Your primary focus will be on identifying areas for improvement and implementing best practices to optimize revenue performance.
Essential Functions And Tasks
- Conduct audits and reviews of revenue cycle processes, including but not limited to billing, collections, and reimbursement, to identify errors, discrepancies, and opportunities for improvement.
- Evaluate the accuracy and completeness of documentation, charge capture, and billing practices to ensure compliance with coding guidelines and regulatory requirements.
- Analyze billing and payment data to identify trends, patterns, and opportunities for process optimization and revenue enhancement.
- Collaborate with revenue cycle staff, coding specialists, billing specialists, and other stakeholders to address audit findings, implement process improvements, and ensure adherence to regulatory standards and best practices.
- Provide education and training to revenue cycle staff on documentation requirements, billing regulations, and revenue cycle best practices.
- Document audit findings, observations, and recommendations in clear and concise audit reports for presentation to management and stakeholders.
- Stay abreast of changes in healthcare regulations, payer policies, reimbursement methodologies, and industry trends affecting the revenue cycle, and ensure compliance with regulatory standards.
- Participate in revenue cycle improvement initiatives, process optimization projects, and system upgrades as needed.
- Assist with internal and external audits, compliance reviews, and regulatory inquiries related to revenue cycle processes.
Education And Experience Requirements
- Bachelor's degree in any related field.
- Minimum of 3 years of experience in healthcare revenue cycle management, with a focus on revenue cycle auditing, compliance, or quality assurance.
- Strong understanding of medical coding, billing, reimbursement, and revenue cycle processes.
Knowledge, Skills, And Abilities
- Knowledge of healthcare regulations, payer guidelines, and compliance requirements related to revenue cycle operations.
- Excellent analytical skills and attention to detail.
- Strong communication and interpersonal skills, with the ability to effectively collaborate with cross-functional teams.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Proficiency in using revenue cycle management software, electronic health records (EHR) systems, and audit tools.
Ventra Health
Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.
Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.
Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.
Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.
To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at [Confidential Information] to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/ .
