A consistent revenue stream is the lifeblood of any medical, dental, or mental health care practice. Incoming revenue is dependent on a properly managed and efficient revenue cycle. When there are delays caused by things like missing information, incorrect information, failure to receive prior authorization, claim rejections, and claim denials it can hamper your practice’s ability to grow.
Not to mention taking up needless time sorting out the reasons for the delay. When your skills would be better served by treating the patients who rely on your care.
With the speed of modern-day business and the increasing intricacies of the insurance industry, you need someone to keep a close eye on your revenue cycle. Though most providers aren’t trained with the skills necessary in revenue cycle management to do the job efficiently. This is where a revenue cycle specialist comes into play.
What Is a Revenue Cycle Specialist?
A revenue cycle specialist is a medical billing expert with the experience and training to manage critical tasks such as claims proofing, claim submitting, payment and collections. They know how to navigate the complexities of the medical billing industry, to streamline the revenue cycle for solo practitioners, small practices, clinics, and even entire hospitals.
Most larger practices, hospitals, major clinics, and healthcare institutions keep at least one if not several revenue cycle specialists on staff. They work diligently to make sure that when services are billed, there is a valid method for collecting payment from patients who don’t have insurance as well as those who do have insurance but haven’t paid their expenses yet.
There are also times when a credit card issuer might refuse to pay a claim due to some sort of price dispute or other processing issues. In a time like this, the revenue cycle specialist steps in to clarify the issue, clear up any concerns and ensure reimbursement in the timeliest manner possible. All without having to distract the provider or other clinical staff from treating patients.
Important Revenue Cycle Specialist Skills
A revenue cycle specialist has to wear a lot of different hats throughout the claims management and reimbursement process. They need to be knowledgeable about current business processes as well as up-to-date on all current medical technology. This includes being knowledgeable of all the latest software and apps being used by providers, insurance companies, and public health institutions.
While it should go without saying that a revenue cycle specialist needs to be an expert with numbers and finances, they must also need to have excellent communication skills. From time to time they will need to connect with others and even engage in savvy negotiations with patients, private insurance companies, other providers from referrals, and public health institutions.
Most professional revenue cycle specialists have an associate degree in finance or a bachelor’s degree in business management. Several institutions such as the American Healthcare Professional Specialists Association (AHPSA) can provide revenue cycle specialists with additional certification to boost their credentials in the industry.
What To Look For In a Revenue Cycle Specialist
When looking for a revenue cycle specialist to add to your thriving practice, there are a few key skills and professional descriptors to keep an eye out for.
A solid work ethic is a critical skill for any revenue cycle specialist. They will need to be committed to getting the job done efficiently and effectively. Any lapses in work ethic by the revenue cycle specialist can lead to massive delays in your practice’s incoming revenue stream.
The Ability to Work Well With Others
Revenue cycle specialists need to be able to work collaboratively with billing, administrative, and collections staff members within your practice. Ideally, you’re looking for a candidate who describes themselves as being a “People Person.”
Strong Communication Skills
Revenue cycle specialists have to work with professionals from many other disciplines in the medical billing and healthcare industries. This makes strong communication skills critical. The ideal candidate will be able to communicate effectively and enable communication across the various departments and specialties, without the need for recurring clarification.
Previous experience with medical billing and collections is certainly beneficial for a successful revenue cycle specialist. Though it isn’t a 100% absolute requirement. So, you want to look for previous educational or professional successes in similar fields or past positions that the candidate has held.
Tech Savvy and Computer Literacy
Revenue cycle specialists need to be adept with general computer skills as well as demonstrate the capacity to learn quickly. They need to be up-to-date and proficient with conventional medical billing software and IT systems. They also need to show an ability to learn new software systems when they become available.
This includes a high level of proficiency with popular computing tools and apps, such as Microsoft Office Suite as well as the latest revenue cycle management software. The ability to use billing and collections data on analytics platforms is also a major benefit for an aspiring revenue cycle specialist hoping to join your practice.
The Benefits of a Revenue Cycle Specialist for Small Practices
A revenue cycle specialist allows clinicians and administrative staff to stay focused on their areas of expertise. In this way, many revenue cycle specialists help to fill in the gaps in the financial operations of a wide range of hospitals and clinics.
They ensure that all other aspects of medical billing and budgeting work efficiently. This includes things like accounting for patient treatments, as well as estimating the cost of new patient onboarding. They also work to provide clear bills for payment to the patient or the patient’s insurance company.
In the event of a failure to pay or a claim that is rejected or denied, the revenue cycle specialist also works to collect past-due commitments. A lot of successful hospitals and clinics rely on balance collections attained by revenue cycle specialists to help sustain their operations.
When you bring a revenue cycle specialist on board or partner with one from a third-party agency, you get to spend more time helping patients and growing the scope of your practice. You also get to enjoy a more consistent revenue stream to confidently plan reinvestment in your practice as it grows.