What are the responsibilities and job description for the REVENUE CYCLE SPECIALIST III position at The Institute for Family Health?
SUMMARY:
The Revenue Cycle Specialist III is cognizant of the philosophy, standards, objectives and policies of the Department and the Organization. The Revenue Specialist shall have complete understanding of revenue cycle processes including billing, collections, charge and payment posting, coding, front end processes, and be able to generate basic reports. This position requires high level work performance with measurable results.
REQUIREMENTS:
- Designated areas of responsibility include but are not limited to Self-pay/Sliding Fee, Managed Care Plans, Medicaid, Medicare, Commercial Plans,Posting payments/denial/charges
- Performs work queue activities according to designated accounts receivables area policy and procedures on a daily basis. The minimum number of accounts to be determined by management.
- Communicate directly with managers, clinicians, consultants, and staff in regards to thecollections of claims for services. This includes coding, Epic system processes, staff errors, denials and rejections, and incorrect payment of claims.
- Manage claims projects as assigned and coordinate efforts with management and provider relations representatives.
- Work Pre-accounts receivable as well as designated accounts receivable areas of focus
- Assist in the departments behavioral health, dental and/or medical claim review initiatives
- Participates in the departments performance improvement activities and offers ideas for new best practices
- Understanding of FQHC, Article 28, Article 31, CMS, managed care and commercial payers
- Understanding of Commercial, Managed Care and Government health plans
- Knowledge of CPT and ICD-9/10 coding and chart review
- Understanding of in-patient vs. out-patient setting, electronic claims processing, and patient accounts
QUALIFICATIONS:
- High School or GED Required
- Minimum of three (3) years of experience working in healthcare claims processing setting; experience requirement may be reduced to minimum of (2) years with medical billing or coding certification Required
- Associates Degree in Finance, Business, or Healthcare preferred
- Completion of Medical Billing and Coding Certification Program preferred
- Advanced knowledge of Microsoft Office applications including Word, Excel, Outlook and PowerPoint Required
- Working knowledge of basic Crystal reports and EPIC reporting workbench preferred
Equal Employment Opportunity/Affirmative Action:
The Institute for Family Health is an Equal Employment Opportunity Employer. This job summary is intended to be brief and may not list all the duties and functions required, however, it does highlight the essential requirements. Nothing outlined in this job summary is to be construed as an express or implied contract of employment.
Please visit www.Institute.org for more information.
