Certified Revenue Cycle Representative

JOB SUMMARY: The Certified Revenue Cycle Representative is a vital member of the hospital's Business Office/Patient Financial Services team, responsible for managing patient accounts, ensuring accurate and timely billing, and effectively following up on outstanding balances. This role requires a strong understanding of healthcare billing processes, insurance regulations, and excellent communication and problem-solving skills. The representative serves as a key point of contact for patients regarding their financial obligations and works collaboratively with internal departments and insurance payers to optimize the revenue cycle. The ideal candidate will be a certified representative with a commitment to accuracy, compliance, and providing exceptional customer service.

Education

GED or High School Diploma (Required)

Certificate, Licenses, Registrations

Certified Revenue Cycle Representative (Required)

Primary Job Duties

• Adheres to Brodstone Healthcare’s Mission, Vision and Values.
• Adheres to Brodstone Healthcare Standards of Behavior.
• Review and analyze patient accounts to ensure accuracy and completeness of billing information.
• Investigate and resolve billing discrepancies, errors, and denials.
• Follow up on outstanding accounts receivable (A/R) through various methods (e.g., phone calls, correspondence, system worklists).
• Document all collection efforts and account activity accurately and thoroughly in the patient accounting system.
• Process patient refunds and adjustments in accordance with hospital policies and procedures.
• Collaborate with other departments (e.g., Patient Access, Health Information Management, Clinical Departments) to obtain necessary information for accurate billing and collection.
• Verify insurance eligibility and coverage for patients.
• Submit electronic and paper claims to insurance payers accurately and timely.
• Monitor claim status and follow up on unpaid or denied claims with insurance companies.
• Analyze Explanation of Benefits (EOBs) and remittance advices to identify payment discrepancies and take appropriate action.
• Initiate and manage the appeals process for denied claims, ensuring all required documentation is submitted.
• Stay updated on payer rules, regulations, and coding guidelines.
• Respond to patient inquiries regarding billing statements, insurance coverage, and payment options in a professional and courteous manner.
• Explain billing procedures, charges, and payment policies to patients.
• Assist patients with setting up payment plans and exploring financial assistance options.
• Resolve patient complaints and concerns related to billing issues, escalating complex issues as needed.
• Maintain patient confidentiality in accordance with HIPAA regulations.
• Adhere to all federal, state, and local regulations related to healthcare billing and collections.
• Comply with hospital policies and procedures related to the revenue cycle.
• Maintain knowledge of current coding (CPT, HCPCS, ICD-10) and billing guidelines.
• Participate in training and educational programs to enhance job knowledge and skills.
• Identify and report potential compliance issues or areas for improvement in the revenue cycle process.
• Utilize the hospital's patient accounting system and other relevant software applications effectively.
• Generate and analyze basic reports related to assigned tasks and account status.
• Maintain accurate and organized records.
• Certification in a relevant revenue cycle field (e.g., CRCR, HBMA).
• Strong understanding of healthcare billing processes, insurance regulations, and coding principles.
• Excellent communication, interpersonal, and customer service skills.
• Proficient in using patient accounting systems and other relevant software.
• Strong analytical and problem-solving skills.
• Ability to work independently and as part of a team.
• Attention to detail and accuracy.
• Ability to maintain confidentiality Perform other duties related to the efficient operation of the business office as directed by management.
• Performs other duties as assigned.