Revenue Cycle Coordinator-Sliding Scale Fee Program, Prior Authorizations, Contracts

Company Overview

The Macoupin County Public Health Department is dedicated to promoting the health and wellness of our community since 1983. With over 140 employees across six locations, we are committed to preventing disease and ensuring access to healthcare services for all residents of Macoupin County.

Summary

The Revenue Cycle Specialist-Sliding Scale Fee Program, Prior Authorizations, Contracts role is a key member and contributor to the success of the Practice. This “attention to detail” position provides in depth support for all insurance related duties of the office to ensure all treatment/procedures ordered by the provider are covered under the patient’s insurance plan or that an appropriate non-covered service agreement and sliding scale fee are in place. The Revenue Cycle Specialist will work closely under the supervision of the Revenue Cycle Manager and will provide support to the Revenue Cycle Dental, Medical, and Behavioral Health Team on a regular basis.

EDUCATION, EXPERIENCE AND SKILLS REQUIRED

• High School diploma or equivalent required.

• One year or more experience in Revenue Cycle/billing and claims adjudication required.

• Demonstrate effectiveness in written and verbal communication.

• Proficiency in Microsoft Office applications.

• Knowledge in Federal and State regulations.

• Accuracy and organization are a must.

• Familiarity with financial plans, Medicaid, Medicare and all private insurance companies.

• Strong communication skills are required.

• Ability to maintain satisfactory working relationships with other employees and general public is a must.

• Ability to be mobile without limitations or restrictions.

• Must be able to perform CPR and any life-saving techniques.

• Must be up-to-date on immunizations and vaccinations.

ILLUSTRATIVE EXAMPLES OF WORK

• Demonstrate compliance in all components of the Sliding Scale Fee Discount Program, which includes assisting patients in the completion of the sliding scale fee eligibility paperwork on an annual basis.

• Process Prior Authorization requests from clinical staff and following up with patients to ensure they are notified of the status of their Prior Authorization and get scheduled for the procedure as appropriate.

• Establish a Non-Covered Service Agreement (also referred to as a “contract”) for patients that need a service that is not covered under their insurance plan.

• Audit active sliding scales in patient charts on a routine basis.

• Document the status of Prior Authorization within the Electronic Health Record/Practice Management system.

• Assist in the resolution of claims with the goal of increasing revenue for the clinic.

• Research and resolution of denials and unpaid claims to avoid loss of aged AR.

• Posting of EOBs will reflect the processing of the claim by the insurance carrier in such a way that balances may be forwarded to the next responsible party, and in a way that all denials can be monitored through reporting by use of line-item reason codes.

• All EOBs posted will be scanned to create an electronic batch based on the date they were posted.

• Adjudication of all unpaid claims.

• Run reports regularly to indicate, via line item reason codes, what claims need re-worked to obtain further resolution based on how the claim denied.

• Run and complete required weekly and monthly reports to secure MCPHD’s financial health.

• Responsible for resolving overdue bill and collecting payment from the individuals responsible for the debt.

• Understands and monitors all business related function of the patient visit from point of entry to accurate adjudication of the patients’ accounts.

• Unpaid claims report run regularly to show which claims have not yet been processed by the billed insurance carrier. Claim status will be checked via phone call or online options, and properly adjudicated based on the claim status.

• Specific areas of responsibility include Revenue Cycle Training, Credentialing, Claims Management, Billing, Collections, Patient Insurance, Date Processing, Integrity of Patient Accounts, Accounts Receivable Management, practice management system file maintenance, and third party revenue cycle vendors.

• Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment.

• Analyzes claims, utilization, and medical, behavioral health, and public health cost data.

• Meets internal goals and external benchmarks in the Revenue Cycle.

• Resolves escalated reimbursement issues with payers and systems for optimal management of account receivable.

• Steps forward to address difficult issues.

• Takes ownership and overcomes Revenue Cycle challenges.

• Develops, implements, maintains the Practice’s Revenue Cycle Standard Operating Procedures (SOPs) for the Health Centers and Health Department.

• May develop training materials to facilitate staff training of SOPs, systems metrics, government regulations, etc.

• Identifies new goals and visions to assist team in maximizing Revenue Cycle return.

• Performs other duties as assigned.

If you are passionate about improving healthcare access and have the skills we need, we invite you to apply for the Revenue Cycle Specialist position at the Macoupin County Public Health Department today!

Job Type: Full-time

Pay: $20.00 - $22.00 per hour

Expected hours: 37.5 per week

Benefits:

• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• No weekends

Work Location: In person

Salary : $20 - $22