Position Summary: The Lead Revenue Cycle Specialist works in conjunction with Revenue Cycle Director to ensure accuracy, consistency and efficiency in relation to code assignments for reimbursement and reporting purposes. The Lead Revenue Cycle Specialist functions include supporting the Business Office staff and achieving departmental goals related to turn around time, clean claim rate, cash collections, aging, and denial management. Extensive knowledge of government insurance agencies (Medicaid and Medicare), as well as Commercial insurance companies and Third Party Administrators. Must be knowledgeable in ICD-10 CM, CPT & HCPCS coding. Must understand & apply all regulations/laws/and standards applicable to coding to ensure appropriate & compliant billing.

Duties and Responsibilities:

• Responsibilities included but are not limited to medical coding, insurance verification, ensuring the accuracy of the information housed in Athena billing system, collecting, posting, and managing account payments (EOB’s), submitting accurate claims, and following up on outstanding accounts with insurance carriers and patients. 
• Analyze payer payment variances, tracks and pursues under-paid and denied accounts receivable.
•  Provides support to all Revenue Cycle Specialist.

• Daily reviews and investigates open tasks holds in Athena’s workflow Dashboards (Mgr Hold) to see why claims rejected or denied and follows through with corrective action i.e. re-bill, corrected claim etc.
• Completes CareConnect charge review error workqueue (coding) creates and maintains custom claim edits and works the client action worklist. 
  • Lead, is responsible for identifying and tracking trends of incorrect coding, errors, and denials and compiling examples to review with Revenue Cycle Director at weekly check-ins. 
  • Develops training presentations to go over guidelines of coding recommendations based on these identified trends to educate fellow team mates.
  • Provides timely and professional customer service, verify discrepancies and resolves closing the cycle loop.
  •  Reviews provider charges to ensure accuracy, reduce claim errors & denials while maintaining compliance.
  • Serve as a resource & mentor to the Business Office staff, assisting them with education and providing resolution to their coding questions as they arise.
  • Responsible for processing patient complaints related to a patient account/invoice.
  • Utilize Encoder Pro as a coding resource tool to assist with CPT/HCPCS/DX code guideline.

• Completes Patient Payment Plan form and submits to Revenue Cycle Director, for approval of presented payment arrangements for uninsured (Self Pay) accounts as needed in accordance to OIC’s payment plan protocol.

• Completes and submits external party refund request form with supporting documentation detailing the validity of such request to Revenue Cycle Director for approval.

• Co-Custodian of subpoenas for Billing records. Works directly with Law Firms to assure timely delivery of records, verifying that proper authorization and copy fees are on file 

• Revenue Cycle Specialist will provide Athena training support to new employees and will share their knowledge and experience with fellow co-workers. 

Servicing Department unique functions:

ASC services- 

• After chart review is completed by coder they will proceed to scan copies of the implant logs onto the shared drive (S). 
• RCS, will email copies of the implant logs to the supply chain manager (appointee)and request copies of detailed manufacturers invoice for specific items used during the surgical case.
• Copies of invoices will be uploaded to the shared drive (S) for easy attachment.

Urgent Care and Specialty Clinic services-

• Review and maintains the Athena work dashboard on a daily basis and makes updates, and corrections in order to release claims to insurance carriers in a timely fashion.
• Verifies patient eligibility and authorization status utilizing I-CAP and payer portals.

Factor services-

• Submits claims to appropriate payer with authorizations and proof of medical necessity upon receipt of charges obtained from the pharmacist.
• Completes the patient accounts sections of the shared 340B spreadsheet on the Finance Department/Pharmacy shared drive. 

Key Performance Indicators and Standards:

• Internal Process Quality- charges to be processed within 24 hours of services rendered in order to reduce charge lag and optimize revenue collection.
• AR days- maintain aging below 120 days (reduction of days in AR).
• Clean Claim Rate- reduce claim rejections/denials based on coding and use of modifier (Rate 90%).
• Payment Collection Rate- Increase payer and patient payment collection from billed date (between 30 to 45 business days). 
• Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct, reports compliance problems appropriately. 

Professional & Personal Development:

• Participates in on-going system trainings as assigned by Revenue Cycle Director.
• Keep current of industry changes.

Service:

• Excellent interpersonal, communication and customer service skills.
• Teamwork
• Ownership/Accountability
• Continuous Performance Improvement.

Qualifications:

• Knowledge of revenue cycle processes, and medical insurance billing guidelines.
• Minimum of three-years’ of experience in Healthcare Accounts Receivable.
• High School Graduate or GED suitable equivalent.
• Certified Professional Coder, CPC.
• Proficient computer skills, including Microsoft Office Applications.
• Knowledge of Confidentiality and rules regarding HIPAA, State and Federal governing release of medical information required. 
• Must have excellent problem-solving skills with the ability to work under pressure and prioritize responsibilities in order to meet deadlines. 
• Ability to effectively communicate with fellow teammates, facility staff, patients, and external parties. 
• High degree of accuracy and attention to detail.
• Knowledge of coding methodology, abstract coding from medical/chart notes and operative report.

Physical Requirements:

• Intermittent (25-35% of the time) walking, standing, bending, sitting and verbally communicating with patients and other OIC healthcare team members
• Requires normal range of vision
• Requires infrequent lifting up to 25 pounds
• Requires prolonged standing or sitting

Work Environment:

• Work is performed indoors in a heated, air conditioned, well lighted and clean office setting.