What are the responsibilities and job description for the REVENUE CYCLE AUDITOR - HME/DME Software Exp A Plus!!!! position at Stance Health Solutions (Western)?
Job Description
Job Description
Description :
Revenue Cycle Auditor
Position Overview :
The Revenue Cycle Auditor is responsible for managing the revenue cycle, which is the process of generating, acquiring, and delivering revenue. Key responsibilities include processing and submitting claims to insurance companies and patients, following up on unpaid claims, resolving discrepancies with payers, ensuring timely collection of payments from insurance companies and patients. The Revenue Cycle Auditor is also responsible for submitting and obtaining all necessary documentation to create revenue for insurance companies. RCA is required to understand and interpret payer contracts and work on and address any complex and intricate revenue-related issues. In addition, RCA will analyze accounts receivable reports, identify repetitive denials, systematic issues, and schedule meetings with payers. RCA needs to identify internal organizational errors arising from other departments and / or system configuration and take appropriate action to resolve them.
Essential Job Functions :
- Process and submit insurance claims to various payers, ensuring accuracy in coding and billing information to minimize denials and delays.
- Review patient accounts to verify correct insurance billing information, update records as necessary, and resolve any discrepancies in patient account balances.
- Analyze denied claims to identify denial reasons and perform the necessary follow-up actions including appealing denied claims with appropriate documentation and justification.
- Analyze accounts receivable reports and take appropriate action to resolve repetitive denials.
- Coordinate with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement.
- Discuss areas needing improvement with the authorization and CMN departments as needed.
- Engage directly with patients to explain their bills, resolve billing inquiries, and set up payment plans for outstanding balances, ensuring a positive customer service experience.
- Engage in written communication and schedule meetings with payers to address aging balances.
- Compiles and submits projects to insurance companies.
- Meet with Revenue Cycle Manager and Director to discuss areas of concern.
- Process and submit authorization and CMN requests to medical groups, plans, and physicians’ offices. Follow-up in a timely manner.
- Process eligibility verification and determine payer, benefits, and coverage criteria.
- Monitor and report on key performance indicators related to revenue cycle activities, such as claim denial rates, time to payment, and outstanding accounts receivable, to identify areas for improvement.
- Work on complex and intricate revenue-related matters.
- Supports global team and provides feedback though QA, reviews and huddles.
- Monitors work completed by global partners and resolves tasks the global team cannot resolve.
- Submits price table, payer rule, and system configuration updates to designated team.
- Implement and adhere to compliance standards and regulations related to medical billing and coding, maintaining confidentiality of patient information in accordance with HIPAA guidelines.
- Participate in the development and testing of new billing software and systems to improve revenue cycle efficiency, including providing feedback on software performance and suggesting enhancements.
Requirements :
Minimum Qualifications
