Revenue Cycle Specialist

Full job description

Southwest Georgia Healthcare Clinic, a FQHC look-a-like, in Donalsonville, Georgia is seeking two revenue cycle specialists to lead their reimbursement and revenue cycle operations.

Position Purpose:

Responsible for timely and accurate billing claim submission to responsible third party payers. Assures compliance with Medicare, Medi-Cal, Commercial Insurances, Federal and State Laws impacting health care. Monitors and creates edits in the electronic billing system to achieve accurate high clean claim ratios. Coordinates office efforts and works closely with Billing Clerks to expedite collections.

Core Duties and responsibilities, include but are not limited to:

• Oversee the operation of the revenue cycle functions of the facility by ensuring the health center receives correct & timely reimbursement for care provided to patients
• Responsible for all reimbursement-related activities of the company
• Provide administrative support & leadership to ensure efficient daily activities of the department
• Ensures that all required information is attached to every billing form, TAR.
• Ensures timely submission and acceptance of claims to all payers.
• Elevates issues with payers and reports improvement as appropriate.
• Assists the AR/Billing Staff,and Performs designated duties when they are absent.
• Assists with the implementation of quality and performance improvement measures for the business office.
• Participates in the development of unit policies and procedures
• Must be capable of performing all tasks required of hourly billing and collection employees.
• Identifies accounts not selected for billing (ANSB). Reviews system generated billing, collections and medical records abstracting reports to monitor weekly collections, billed and unbilled accounts.
• Identifies and collects on underpaid accounts.· Recommends future course of action based on data interpretation and recommends system changes, as appropriate.
• Reviews Claims Edit List to monitor specific issues, as well as recurring issues and resolution.
• Communicates issues that are preventing timely and accurate billings to Ceo for performance improvement process.
• Uses a wide variety of communication formats to keep staff regularly informed and trained with one to one and team meetings.
• Serves as a resource to staff by answering questions, assisting with problems, and providing training as necessary.
• Ensures appropriate and professional communication with payers and patients.
• Reviews and resolves issues related to claim generations, clean claim ratios, rejected, denied billings. Determines the accuracy of charge capture, missing charges, late charges, covered and non-covered charges.
• Other duties as assigned but within scope

This job description in no way states or implies that these are the only duties to be performed by the employee. He or she will be required to follow any other instructions and to perform other duties, within scope, as assigned by the CEO.

Qualifications, Skills, and Experience:

• Bachelor’s degree in Health, Accounting, or related field preferred.
• Certification/license in medical billing or coding required.
• Minimum of two years of supervisory billing experience required, preferably in an FQHC setting.
• At least two years of knowledge and experience working with Federally Qualified Health Centers (FQHCs) preferred.
• Advanced knowledge of Excel is preferred.
• Strong oral and written communication skills.
• Ability to work independently and manage critical tasks under deadlines.
• Knowledge and experience with Medicare, Medi-Cal, insurance plans, contract payers, and government entities.