Senior ASC Revenue Cycle Management… at Jax Spine &… · Jacksonvi…

Centurion Surgery Center - Jacksonville Reports to: ASC Revenue Cycle Consultant / ASC RCM Leadership Department: ASC Revenue Cycle Operations Position Summary: The Senior ASC Revenue Cycle Specialist is responsible for advanced revenue cycle operations supporting the Ambulatory Surgery Center, with a primary focus on accounts receivable, denial management, reimbursement optimization, and revenue integrity. This role serves as a senior technical resource within the Revenue Cycle department, utilizing broad end-to-end revenue cycle expertise to resolve complex reimbursement issues, identify trends, improve workflows, and support continuous operational improvement. This position works independently while collaborating with leadership and other revenue cycle team members to maximize reimbursement, improve operational efficiency, and ensure compliance with payer requirements. The Senior ASC Revenue Cycle Specialist is not a supervisory position but serves as a technical subject matter expert and mentor within the department. Accounts Receivable & Reimbursement: Manage complex insurance accounts receivable across all payer types. Investigate and resolve denied, underpaid, and outstanding claims. Analyze EOBs and remittance advice to ensure accurate reimbursement. Identify reimbursement discrepancies and recommend appropriate account corrections. Work timely filing, high-dollar, aging, and specialty work queues based on departmental priorities. Denials Management: Investigate and resolve payer denials using payer guidelines and contract knowledge. Prepare and submit appeals and supporting documentation. Identify denial trends and recommend corrective actions. Collaborate with coding, authorization, and clinical staff to prevent recurring denials. Monitor appeal outcomes and identify opportunities for reimbursement improvement. Revenue Integrity: Review reimbursement accuracy and contractual payment variances. Assist with payment variance research and revenue recovery opportunities. Identify payer processing issues affecting reimbursement. Ensure accounts accurately reflect contractual adjustments and patient responsibility. Workflow Development & Process Improvement: Assist leadership in developing and documenting standardized revenue cycle workflows. Create reference materials and process documentation as workflows evolve. Recommend operational improvements that increase efficiency and reduce rework. Participate in implementation of new revenue cycle initiatives and system enhancements. Reporting & Trend Analysis: Analyze accounts receivable to identify reimbursement trends and operational opportunities. Assist leadership with KPI monitoring and revenue cycle reporting. Recommend priority work queues based on reimbursement impact. Report findings and opportunities to Revenue Cycle leadership. System & Clearinghouse Management: Utilize SIS Complete, Waystar, payer portals, and other revenue cycle systems effectively. Research clearinghouse edits, payer rejections, and claim submission issues. Assist with payer portal administration and user access as assigned. Support optimization of system workflows and revenue cycle functionality. Collaboration & Technical Support: Serve as a technical resource for Revenue Cycle Specialists and other department staff. Assist with cross-training and knowledge sharing. Provide guidance on complex reimbursement scenarios. Collaborate with Coding, Payment Posting, Scheduling, Financial Clearance, and Leadership to improve overall revenue cycle performance. Special Projects: Participate in revenue cycle audits and cleanup initiatives. Assist with historical A/R projects and reimbursement recovery efforts. Support implementation of new surgery centers and revenue cycle workflows as the organization grows. Perform additional revenue cycle projects as assigned. Qualifications: Required Experience: Five (5) or more years of progressive medical revenue cycle experience. Extensive experience with insurance follow-up, denials, appeals, and accounts receivable. Broad end-to-end revenue cycle knowledge including eligibility, claim submission, payment posting concepts, reimbursement, and collections. Experience working with commercial, Medicare, Medicaid, Workers' Compensation, and other government payers preferred. Ambulatory Surgery Center experience preferred. Education: Associate's degree preferred. Equivalent combination of education and relevant revenue cycle experience will be considered. Technical Skills: Experience with Practice Management systems and clearinghouses. Experience with Waystar preferred. Strong understanding of payer guidelines, reimbursement methodologies, and EOB interpretation. Proficiency with Microsoft Office applications, particularly Excel. Ability to analyze reports and identify reimbursement trends. Professional Attributes: Strong investigative and analytical problem-solving skills. Excellent organizational and time management abilities. Exceptional attention to detail. Strong written and verbal communication skills. Self-motivated with the ability to work independently. Professional, collaborative, and accountable. Positive, solution-oriented mindset. Ability to adapt to changing priorities in a fast-paced healthcare environment. Work Environment: Hybrid work model if desired with on-site collaboration during initial transition and training period, with flexibility as workflows are established. Team-oriented environment focused on building a high-performing revenue cycle operation supporting current and future ASC growth.