Revenue Cycle Specialist Insurance Follow Up Hybrid

A Brief Overview

Entry level position responsible for submitting and resolving medical claims of low to moderate complexity. Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.

• Responds to requests from management, staff, or physicians in a timely and appropriate manner.
• Maintains patient and physician confidentiality and professionalism at all times.
• Follows department policies and procedures to ensure accurate and timely claim resolution.
• Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
• Attends and participates in team meetings.
• Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
• Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
• Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
• Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
• Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
• Contacts patients and guarantors to secure necessary billing information.
• Documents accounts with clear and concise verbiage in accordance with departmental procedures.
• Reviews and responds to correspondence and inquiries received.
• Meets and exceeds team productivity and quality standards.
• Performs other related duties as assigned.

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Education

• High School Equivalent / GED (Required) and
• Associate's Degree in a related field (Preferred) and
• Bachelor's Degree in a related field, (Preferred)

• 1 years of experience in call center, patient registration, scheduling, office, banking, customer service or related medical field using computers. (Required) and
• Experience with medical billing software (Preferred)

• Detail-oriented and organized, with good analytical and problem solving ability. (Required proficiency)
• Notable client service, communication, and relationship building skills. (Required proficiency)
• Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
• Must have strong written and verbal communication skills. (Required proficiency)
• Demonstrated ability to use PCs, Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency)

• Certification in Medical Billing/Coding from a recognized program, will be accepted in lieu of 1 year of work experience. (Required within 1 Year)
• Medical Billing/Coding certification (Preferred)

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

• 10%