What are the responsibilities and job description for the Revenue Cycle Management Specialist - Billing position at KPH Healthcare Services?
Overview
Job Summary: The Revenue Cycle Management Specialist- Biller responsibility is to manage the process of the company's billing function including accurate and timely claim creation and submission.
Responsibilities
- Accurately prepare and submit claims for payment from all third-party payers in a timely manner.
- Verify documentation of supplied products align with prepared claim.
- Verify accuracy of billed codes and accuracy of billed and expected amounts.
- Support the resolution of billing issues such as claim resubmissions to all payers, changes in coverage, and claims
- Follow up on submitted claims and resolve rejected claims, including claim corrections, update payer ID, update patient insurance record, etc.
- Prepare and submit patient statements.
- Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about
- Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.
- Assist in the implementation of processes to measure, assess, and improve the performance of the billing department activities of the company.
- Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement "best practices" in all departmental
- Participate in surveys conducted by authorized inspection
- Participate in the company's Performance Improvement program as requested by the Performance Improvement
- Participate in company committees when
- Participate in in-service education programs provided by the company.
- Pursue continuing education programs appropriate to job
- Perform other duties as assigned by
- Complete all mandatory and regulatory training programs.
- Report any misconduct, suspicious or unethical activities to the Compliance
- Complies with accepted professional standards and practice.
Qualifications
Educational Requirements:
- High school diploma or GED
Experience:
- One to three years of experience in Home Infusion or Specialty Pharmacy billing.
Job Skill Requirements:
- Ability to read and interpret medical records for billing purposes.
- Competent in mathematic equations.
- Ability to compute unit conversions for drugs.
- Understanding of CPT, HCPCS, and ICD-10 codes
- Has excellent attention to detail and communication skills.
- Understanding of HIPAA compliance.
- Self-directed, has the ability to work with little supervision.
- Proficiency in Excel, Outlook, and all other office applications.
- Familiarity with pharmacy management systems (CPR , Wellsky, and CareTend, etc.)
- Familiar with billing requirements for various payers (Medicare, Medicaid, Commercial, etc.)
- Knowledge and experience submitting pharmacy and medical claims electronically or on paper.
