Revenue Cycle Specialist

Position Summary:  The Revenue Cycle Specialist is responsible for the full cycle of processing claim submission to Medicaid, Medicare, Commercial insurance companies and Third Party Administrators. This position will handle questions, complaints, or problems from insurance companies, Medicaid offices and their associated Managed Care Plans, Medicare regions and their associated Health Maintenance Organizations. Revenue Cycle Specialist will assist with patient’s phone calls or walk in inquiries regarding insurance payments and or outstanding balances. Collaborates with authorizations and registration department to optimize reimbursement and minimize denials. All tasks must be performed in accordance to best practices, Policies, and Procedures.

Duties and Responsibilities:

• Maintains Athena Billing system by entering accurate data, verifying and updating insurance, and claims information, handles carrier correspondence, manages EOBs, and post payments received into the system as needed. 
• Daily reviews and investigates open tasks holds in Athena’s workflow Dashboards (CBO Hold and Mgr Hold) to see why claims rejected or denied and follows through with corrective action which may require re-billing missing claims, denied claims or sending additional information on pending claims. 
  • Reviews and provides Revenue Cycle Director weekly productivity updates of any challenges, bottlenecks and or noted trends observed at scheduled check-ins. 
  • Adheres to instructions, verbal and written, to achieve departmental goals.
• Responds to and interacts with internal and external parties in all aspects of billing through phone, email or regular mail in a prompt professional manner.
• Effectively monitors assigned Athena and CareConnect work queues and workload, ensuring quick turnaround resolution of accounts in a timely manner and makes notations of action taken.
• Exemplifies high standards of professionalism, responsibility, accountability and ethical behavior.
  • All claims need to be processed at 100% to ensure meeting Month End closure.
• Utilize Encoder Pro as a coding resource tool to assist with CPT/HCPCS/DX code guideline.

• Review all incoming EOBS for appropriate adjudication and payment, appeal claims that were denied or underpaid and closes the loop with positive results. 
• Completes Patient Payment Plan form and submits to Revenue Cycle Director, for approval of presented payment arrangements for uninsured (Self Pay) accounts as needed in accordance to OIC’s payment plan protocol.

• Completes and submits external party refund request form with supporting documentation detailing the validity of such request to Revenue Cycle Director for approval.

• Co-Custodian of subpoenas for Billing records. Works directly with Law Firms to assure timely delivery of records, verifying that proper authorization and copy fees are on file 

• Revenue Cycle Specialist will provide Athena training support to new employees and will share their knowledge and experience with fellow co-workers. 
• Collaborates in troubleshooting with Lead Revenue Cycle Specialist in finding resolution to any pending AR accounts. 
• All other duties as assigned 

       Servicing Department unique functions:

ASC services-

• After chart review is completed by coder they will proceed to scan copies of the implant logs onto the shared drive (S).
• RCS, will email copies of the implant logs to the supply chain manager (appointee)and request copies of detailed manufacturers invoice for specific items used during the surgical case.
• Copies of invoices will be uploaded to the shared drive (S) for easy attachment.

Urgent Care and Specialty Clinic services-

• Review and maintains the Athena work dashboard on a daily basis and makes updates, and corrections in order to release claims to insurance carriers in a timely fashion.
• Verifies patient eligibility and authorization status utilizing I-CAP and payer portals.

Factor services-

• Submits claims to appropriate payer with authorizations and proof of medical necessity upon receipt of charges obtained from the pharmacist.
• Completes the patient accounts sections of the shared 340B spreadsheet on the Finance Department/Pharmacy shared drive. 

Key Performance Indicators and Standards:

• Internal Process Quality- charges to be processed within 24 hours of services rendered in order to reduce charge lag and optimize revenue collection.
• AR days- maintain aging below 120 days (reduction of days in AR).
• Clean Claim Rate- reduce claim rejections/denials based on coding and use of modifier (Rate 90%).
• Payment Collection Rate- Increase payer and patient payment collection from billed date (between 30 to 45 business days). 

Professional & Personal Development:

• Participates in on-going system trainings as assigned by Revenue Cycle Director.
• Keep current of industry changes.

Service:

• Excellent interpersonal, communication and customer service skills.
• Teamwork
• Ownership/Accountability
• Continuous Performance Improvement.

Qualifications:

• Knowledgeable of full revenue cycle process. 
• Minimum of two-years’ experience with AR workup.
• Certified in Medical Billing program (CPB) or 3 plus years’ experience in Billing. 
• High School Graduate or GED suitable equivalent.
• Proficient computer skills, including Microsoft Office Applications.
• Knowledge of Confidentiality and rules regarding HIPAA, State and Federal governing release of medical information required. 
• Must have excellent problem-solving skills with the ability to work under pressure and prioritize responsibilities in order to meet deadlines. 
• Ability to effectively communicate with fellow teammates, facility staff, patients, and external parties. 
• High degree of accuracy and attention to detail.

Physical Requirements:

• Intermittent (25-35% of the time) walking, standing, bending, sitting and verbally communicating with patients and other OIC healthcare team members
• Requires normal range of vision
• Requires infrequent lifting up to 25 pounds
• Requires prolonged standing or sitting

Work Environment: