What are the responsibilities and job description for the Specialist- Revenue Cycle position at North Mississippi Medical Center System?
Tupelo
BUSINESS SERV-BILLI
Full Time - Day
At North Mississippi Health Services, our mission is to “continuously improve the health of the people of our region.” Our vision is to “provide the best patient and family-centered care and health services in America.” We believe that fulfilling our mission and vision calls us to embrace the best people that form incredible connections to our patients and families.
We take pride in celebrating everything that makes you uniquely you – your talents, your perspectives, and your passions. At North Mississippi Health Services, we believe in connecting your passion with a purpose. When you are part of our team, you know what connected feels like.
**Billing & Follow Up:** * Process Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format. * Billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim. * Information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment. **Denial Management:** * Manage denial receivable to resolve accounts * Develops strategy for appeal, appeal follow-up and/or reprocessing accounts * Analyze denials to determine reason they occurred * Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager * Takes corrective action through systematic and procedural development to reduce or eliminate payment issues **Contract Management:** * Familiarity with payer methodologies and the ability to communicate with NMHS staff * Manage paid claims to resolve underpaid accounts * Develops strategy for appeal, appeal follow-up and/or reprocessing accounts * Analyze underpayments to determine reason they occurred * Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager. **Communication:** * Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance **Liaison:** * Contacts insurance companies regarding denial, underpayments or rejection issues * Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues **Reporting:** * Assists in preparation of monthly denial reports and other denial reports as requested * Assists in preparation of monthly variance reports and other variance reports as requested. **Regulation**: * Adheres to NMHS/NMMC Policies/Procedures/Guidelines. * Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues. Job Knowledge: * Bachelors degree in business, coding or equivalent field required; with a minimum of 2-year Claims, Billing/ Follow-Up, or revenue cycle experience required. Willing to consider 6 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of degree. * Experience/knowledge of managed care reimbursement methodology including ICD-10, CPT-4 and/or HCPCS and DRGs, required * Ability to research, analyze and communicate payer trends to identify reimbursement and training issues. * Excellent analytical and problem-solving skills required * Good organizational and communication (written and verbal) skills; required * Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites; preferred * Excellent interpersonal skills; required.
Bachelors
BUSINESS SERV-BILLI
Full Time - Day
Posting Description
At North Mississippi Health Services, our mission is to “continuously improve the health of the people of our region.” Our vision is to “provide the best patient and family-centered care and health services in America.” We believe that fulfilling our mission and vision calls us to embrace the best people that form incredible connections to our patients and families.
We take pride in celebrating everything that makes you uniquely you – your talents, your perspectives, and your passions. At North Mississippi Health Services, we believe in connecting your passion with a purpose. When you are part of our team, you know what connected feels like.
Job Description
**Billing & Follow Up:** * Process Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format. * Billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim. * Information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment. **Denial Management:** * Manage denial receivable to resolve accounts * Develops strategy for appeal, appeal follow-up and/or reprocessing accounts * Analyze denials to determine reason they occurred * Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager * Takes corrective action through systematic and procedural development to reduce or eliminate payment issues **Contract Management:** * Familiarity with payer methodologies and the ability to communicate with NMHS staff * Manage paid claims to resolve underpaid accounts * Develops strategy for appeal, appeal follow-up and/or reprocessing accounts * Analyze underpayments to determine reason they occurred * Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager. **Communication:** * Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance **Liaison:** * Contacts insurance companies regarding denial, underpayments or rejection issues * Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues **Reporting:** * Assists in preparation of monthly denial reports and other denial reports as requested * Assists in preparation of monthly variance reports and other variance reports as requested. **Regulation**: * Adheres to NMHS/NMMC Policies/Procedures/Guidelines. * Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues. Job Knowledge: * Bachelors degree in business, coding or equivalent field required; with a minimum of 2-year Claims, Billing/ Follow-Up, or revenue cycle experience required. Willing to consider 6 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of degree. * Experience/knowledge of managed care reimbursement methodology including ICD-10, CPT-4 and/or HCPCS and DRGs, required * Ability to research, analyze and communicate payer trends to identify reimbursement and training issues. * Excellent analytical and problem-solving skills required * Good organizational and communication (written and verbal) skills; required * Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites; preferred * Excellent interpersonal skills; required.
Requirements:
Licenses
You must have the following licenses to apply:Education
You must have the following education to apply:Bachelors
