HYBRID Revenue Cycle Specialist III - 241398

Overview: The Revenue Cycle Specialist performs a wide spectrum of billing functions to minimize accounts receivable and enhance collection performance. This position is relied upon to train staff and work on any activity within the team with little supervision. Utilize electronic medical billing systems as well as in depth advanced knowledge of medical billing and insurance rules and regulations to resolve accounts receivables issues. This position serves as the primary resource on complex issues and specified duties. They will be doing medical, dental, behavioral health, and ER billing so we can consider candidates from any of these backgrounds. Any KPI's will vary based on which specialty they are aligned to, so she didn't provide us with these.

Responsibilities:

• Meet deadlines and productivity standards for EPIC work queues, including but not limited to: Insurance verification (Epic RTE), Denials (research root cause, identify trends, correct, appeal), Claim Edits (ensure clean claim submission) & Transaction history (track claim submission and payor response)
• Work the priority EPIC work queues , projects and/or accounts and provide immediate feedback to management.
• Utilize payor websites to research policies and coverage eligibility for use in claim adjudication, trend identification, and application for process improvement.
• Utilize MS Office, with an emphasis on Excel to document, trend, and communicate workflow assignments, trends, and information vital to performance.
• Apply transfers and/or adjustments to invoices as necessary to complete the resolution of each invoice.
• Knowledge of ICD-10, Modifiers,Revenue Codes, HCPCS and CPT codes.
• Coordinate data to complete special billing projects based on contractual obligations and regulatory demands.
• Apply knowledge of insurance rules and regulations to interpret new insurance/HCFA/UB/HIPAA information and report potential impact.
• Work along Patient Accounts Leadership with various payors as part of the contact group responsible for updates and information required to assist others in the organization.
• Participation in various projects and testing of updates for evaluation and implementation.

Important: The Revenue Cycle Specialist will be tracked on performance and they will be provided with equipment (monitor and laptop). This position will be primarily remote but the talent will need to be available to go onsite as needed - typically ends up being 1-2 times per month.

Schedule/Shift: Monday-Friday 8:30am-5:15pm with a 45 minute unpaid lunch and a 15 minute break (all will be scheduled)