Revenue Cycle Specialist

General Summary: Under supervision of Revenue Cycle Manager, the Revenue Cycle Specialist performs various day-to-day patient accounts functions for our Medical programs, including patient and third-party billing, remittance advice and payment processing, problem resolution, statement processing, old balance review, and account inquiry. Billing specific software includes: eClinicalworks, Claim Remedi, Trizetto, Availity, GA Medicaid system, SC Medicaid system.

Major Areas of Responsibility: 

• Coordinate the initiation and processing of claims through practice management software and through manual entry at third-party payor websites;
• Verify insurance via ECW and/or third-party sites
• Scrub claims in order to comply with applicable coding and billing guidelines; Comparing progress notes for coding and diagnose accuracy
• Creating batches of medical claims (1500/UB) to be sent to the patient’s medical insurance including Chronic Care Management and Medicare Wrap claims
• Add quality codes to claims to receive incentives from insurance payers
• Correct and re-process clearinghouse-initiated rejections;
• Review and maintain follow up associated with unpaid/rejected claims, making corrections/adjustment as necessary; which includes submitting claim disputes and/or appeals for denied claims
• Troubleshoot problems as detected in various billing and collections processes and document solutions;
• Review patient accounts for possible refund scenarios, in coordination with the Revenue Cycle Manager;
• Occasionally provide customer service to patients inquiring about their accounts or those with outstanding balances; Other billing- and collections-related duties, as assigned.

Required Knowledge, Skills, Abilities:

• Eager and able to embody the mission and vision of CCH;
• Able and willing to demonstrate love, compassion, and genuine care when interacting with others;
• Thorough knowledge of medical/dental and insurance terminology and payment collection practices;
• Basic-to-intermediate knowledge of medical coding rules and guidelines, including CPT and ICD-10.
• Very high attention to detail and a desire for continual learning and improvement;
• Strong interpersonal communication skills that allow for regular and effective communication of sensitive and confidential information with a variety of people, including patients, third-party payors, and providers
• Able to prioritize work and work independently to meet deadlines, while proactively engaging supervisor and co-workers when needed.
• Strong overall computer skills, including meaningful experience working within an EHR platform and basic experience with Microsoft Excel.

Education and Experience: 

• A high school diploma or equivalent is required.
• CPC certification is preferred but not required.
• At least two (2) years of billing & coding experience, including charge capture, claims processing, and collections in a primary medical care setting is required
• Recent experience working with EHR eClinicalWorks and/or clearinghouse ClaimRemedi and Trizetto is highly preferred.
• Experience within the framework of a federally qualified health center (FQHC) and Behavioral health
• Bilingual skills (English & Spanish) preferred

Working Conditions: The position has normal office working conditions with the absence of disagreeable elements.

Note: The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified.  Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.