Revenue Cycle Specialist

Overview

Now Hiring: Revenue Cycle Specialist

Remote

Full Time Hours: Monday - Friday

Our Benefits:

• Comprehensive Medical, Dental, & Vision insurance
• Competitive 401(k) plan with company match
• Company paid group term life insurance and short-term disability 
• Generous PTO: Paid vacation, personal time, sick Leave, and extended sick leave
• Employee Assistance Program (EAP) offering continued support to employee lifestyle and well-being
• Career advancement opportunities across a leading national network

Job Responsibilities:

• Responsible for updating patient Billing Episodes and crediting account, as appropriate.
• Review and resolve prior authorization/precertification/referral issues that are not valid and contact insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial.
• Validates all necessary referrals/prior authorizations/pre-certifications for scheduled services are on file and shared with all appropriate staff and are valid for the scheduled services performed.
• Ensure all account activity is documented in the appropriate system and shared with all appropriate staff timely and thoroughly.
• Clinic Emails – responsible for managing clinic emails throughout the day. All clinic emails must be responded to in a timely manner.
• Identify, Correct and forward potential reimbursement problems to Revenue Cycle Manager.
• Proactively interacts with Clinics and other appropriate staff sharing benefits, authorizations, and eligibility.
• Responsible for billing all patient claims in a timely manner (weekly billing, secondary and out-of-network plans).
• Review claims issues make corrections as needed and rebill. Utilize claims clearinghouse, EMRs and payor portals to review and correct claims and to resubmit electronically when available.
• Responsible for evaluating bill cycles and changing/updating when necessary.
• Responsible for printing daily billing reports – both electronic and paper claims. Monitor validation percent.
• Work daily claims rejection lists including but not limited to; claims rejected due to auto eligibility process during weekly billing and “Rejected” claims due to eligibility, coordination of care and authorization as part of accounts receivable.
• Gathers and interprets data from the system and understands appropriate courses of action to take and initiates time-sensitive and strategic steps resulting in payment.
• Call and status outstanding claims with third party payors.
• Review explanation of benefits to ascertain that claim processed and paid correctly.
• Document account follow-up where appropriate.
• Identify trends and work with the Revenue Cycle Manager for resolution.
• Perform other duties as assigned.

Qualifications

Your Education, Skills, & Qualifications:

• High school diploma or equivalent; prefer some college or technical school coursework.
• 2+ years of healthcare billing/AR experience, preferred.
• Healthcare payor claims follow-up or accounts receivable experience.
• Healthcare background with payor appeals experience.
• Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.
• Knowledge of office administration procedures with the ability to operate most standard office equipment.
• Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality.
• Excellent interpersonal skills include the ability to interact effectively and professionally with individuals at all levels; both internal and external.
• Exercises sound judgment in responding to inquiries; understands when to route inquiries to the next level.
• Self-motivated with strong organizational skills and superior attention to detail.
• Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes.
• Capable of working within established policies, procedures and practices prescribed by the organization.
• English sufficient to provide and receive instructions/directions.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

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