Revenue Cycle Specialist

Overview

Now Hiring: Revenue Cycle Specialist Remote Full Time Hours: Monday - Friday Our Benefits: Comprehensive Medical, Dental, & Vision insurance Competitive 401(k) plan with company match Company paid group term life insurance and short-term disability Generous PTO: Paid vacation, personal time, sick Leave, and extended sick leave Employee Assistance Program (EAP) offering continued support to employee lifestyle and well-being Career advancement opportunities across a leading national network Job Responsibilities: Responsible for updating patient Billing Episodes and crediting account, as appropriate. Review and resolve prior authorization/precertification/referral issues that are not valid and contact insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial. Validates all necessary referrals/prior authorizations/pre-certifications for scheduled services are on file and shared with all appropriate staff and are valid for the scheduled services performed. Ensure all account activity is documented in the appropriate system and shared with all appropriate staff timely and thoroughly. Clinic Emails – responsible for managing clinic emails throughout the day. All clinic emails must be responded to in a timely manner. Identify, Correct and forward potential reimbursement problems to Revenue Cycle Manager. Proactively interacts with Clinics and other appropriate staff sharing benefits, authorizations, and eligibility. Responsible for billing all patient claims in a timely manner (weekly billing, secondary and out-of-network plans). Review claims issues make corrections as needed and rebill. Utilize claims clearinghouse, EMRs and payor portals to review and correct claims and to resubmit electronically when available. Responsible for evaluating bill cycles and changing/updating when necessary. Responsible for printing daily billing reports – both electronic and paper claims. Monitor validation percent. Work daily claims rejection lists including but not limited to; claims rejected due to auto eligibility process during weekly billing and “Rejected” claims due to eligibility, coordination of care and authorization as part of accounts receivable. Gathers and interprets data from the system and understands appropriate courses of action to take and initiates time-sensitive and strategic steps resulting in payment. Call and status outstanding claims with third party payors. Review explanation of benefits to ascertain that claim processed and paid correctly. Document account follow-up where appropriate. Identify trends and work with the Revenue Cycle Manager for resolution. Perform other duties as assigned.

Qualifications

Your Education, Skills, & Qualifications: High school diploma or equivalent; prefer some college or technical school coursework. 2+ years of healthcare billing/AR experience, preferred. Healthcare payor claims follow-up or accounts receivable experience. Healthcare background with payor appeals experience. Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint. Knowledge of office administration procedures with the ability to operate most standard office equipment. Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality. Excellent interpersonal skills include the ability to interact effectively and professionally with individuals at all levels; both internal and external. Exercises sound judgment in responding to inquiries; understands when to route inquiries to the next level. Self-motivated with strong organizational skills and superior attention to detail. Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes. Capable of working within established policies, procedures and practices prescribed by the organization. English sufficient to provide and receive instructions/directions. We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws. #LI-AH #LI-BS1