What are the responsibilities and job description for the Revenue Cycle Specialist Team Lead-Full Time position at Centra Medical Group?
The Lead Revenue Cycle Specialist is responsible for the company's third-party medical claims processing. This position works with the computerized practice management system for the validation, submission, and processing of insurance and self-pay claims. The position is responsible for collecting and entering claim information, validation, and correction of rejected claims, and claim submission to third-party payers for reimbursement. The Lead also assigns and monitors workload and process workflow for an assigned group of employees. The position also provides continual education and on the job training to staff as areas of opportunity are identified. The lead will work closely with management to set key performance indicators, monitor performance, and provide feedback up and down the department chain. This position is a key change agent in identifying opportunities for improvement within the claims processing workflow for revenue cycle.
Required Education: High School Diploma / GED
Preferred Education: Associates Degree
Required Experience: Minimum of three (3) years of experience in healthcare, insurance, or revenue cycle operations
Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information
Ensures claim information is complete and accurate
Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS- form or UB
Follows up with insurance company on unpaid or rejected claims
Resolves issue and re-submits claims
Prepares appeal letters to insurance carrier when not in agreement with claim denial
Collect necessary information to accompany appeal
Provides necessary information to collection agencies for delinquent or past due accounts
Compiles data for trending of errors and rejected claims
Serves as a resource for revenue cycle specialist
Directs daily operational tasks to ensure completion and adhere to policy and procedure to achieve set KPI goals
Reviews at random claims per employee for audit purposes each week and provides feedback to each employee on the findings
Responsible for producing productivity reports and sharing them with the team on a weekly basis
Creates reports of compiled data to present to leadership for issue escalation and resolution
Possesses the ability to work in a constantly changing work environment and emphasis on attention to detail
Ability to work collaboratively within the department and organization
Ability to maintain confidentiality
Ability to work independently and remote as needed
Must have excellent organizational skills and the ability to prioritize and coordinate workload with a high degree of proficiency and accuracy
May perform other duties as assigned or requested and job specification can be modified or updated at any time
