REVENUE CYCLE SPECIALIST

Job Description

Job Description

Position Purpose : The Revenue Cycle Specialist role is to provide support to the organization to address all revenue cycle management needs. This includes identifying trends that would impact revenue, work on patient claims, follow up on denial and rejection related issues, and work on special projects as needed.

Position Requirements / Qualifications :

Education / Experience :

High School Graduate or GED required. At least two (2) years’ work experience in a healthcare front office setting. CPC certification preferred. Knowledge of Medicaid / Medicare insurance, collections, and Explanation of Benefits (EOB). Must have experience in healthcare Billing and Revenue Cycle operational workflow.

Licensure / Certification :

Maintain current CPR certification from the American Heart Association.

Skills / Ability :

Ability to work as a team member. Must have clerical skills. Must have knowledge of math, operation of calculator, telephone etiquette, human relation skills and organizational skills. Must be computer literate. Demonstrate effective oral and written communication skills. Familiar with Managed Care Contracts, Medical Terminology, ICD-10, and CPT Codes. Knowledge of collections processes and procedure.

POSITION RESPONSIBLITIES (THIS IS A NON-EXEMPT POSITION)

• Responsible for identifying, analyzing, and managing Process Improvement projects in the Revenue Cycle area.
• Responsible for working the Billing Work Queue impacting revenue for timely review and claims submission (Front / Back Office functions).
• Monitor patient account details for billing related issues.
• Reporting claims status to clients on a regular basis to ensure accurate communication between departments within a healthcare organization.
• Knowledge of payer guidelines and policies.
• Identify and communicate with Director of Patient Access / Office Managers of the front office trends impacting claims rejection / denials for training opportunities.
• Provide support to RCM Manager, Coder, Site Office Managers and CBO Vendor in order to expedite claims payments.
• Coordinating with other departments to ensure that billing cycles are completed efficiently.
• Work the monthly and cumulative missing encounter report by validating open encounters are truly missing and working with the clinicians to ensure that they complete documentation and close encounter.
• Access and navigating through various payer portals for claims reconsideration and processing.
• Follow up on unpaid claims, appeals of denied claims and post payments / adjustments accordingly.
• Review the closed encounters that appear on the missing encounter report to validate a charge filed in Transaction Inquiry.
• Supports manager / supervisor in identification of potential loss revenue related to trends in charge entry, billing, coding, or contracting practices that are related to charge capture.
• Utilize the coding resources to understand procedures that are denied.
• Identify and communicate global payer issues with RCM, Managed Care and Back Office Vendor to generate evidence-based appeals for claims processing reconsiderations.
• Understand Managed Care Contracts and various aspects of patient access to maximize claims reimbursement.
• Monitor and review monthly Chronic Care Management invoices for Medicare reimbursement.
• Responsible for receiving, tracking, and entering hospital encounters into Epic for billing reimbursement.
• Export claims data from EHR into RCM Vendor portal for charge posting and billing.
• Follow up with all outstanding AR projects as directed by RCM Manager.
• Review the Provider Flow fax portal for correspondence communication and distribution.
• Complete and submit Quest Diagnostic missing billing details for processing.
• Establishes and maintains good interpersonal relationships with clients and staff.
• Participates in the RCM monthly meeting with vendor.
• Export claims data from EHR into RCM Vendor portal for charge posting and billing.
• Follow up with all outstanding AR projects as directed by RCM Manager.
• Maintains open communication using appropriate chain of command regarding departmental issues.
• Performs other duties as assigned.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER