Revenue Cycle Coordinator

Job Summary

The Revenue Cycle Coordinator at North Mississippi Health Services supports timely and effective Revenue Cycle flow to facilitate payment capture through bill processing and denial and contract management. This position engages strong technical knowledge, as well as organizational and communication skills to manage follow up and coordination with payers, vendors, and staff members to resolve claim issues, facilitate contractual compliance, generate reporting, analyze opportunities for improvement, and implement solutions to realize more effective flow and support of payment capture.

Job Functions

• Billing & Follow Up:
  • Processes Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format.
    • Completes Billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim.
    • Facilitates information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment.
• Denial Management:
  • Manages denial receivable to resolve accounts.
    • Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
    • Analyzes denials to determine reason they occurred.
    • Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager.
    • Takes corrective action through systematic and procedural development to reduce or eliminate payment issues.
• Contract Management:
  • Possesses familiarity with payer methodologies and the ability to communicate with NMHS staff.
    • Manages paid claims to resolve underpaid accounts.
    • Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
    • Analyzes underpayments to determine reason they occurred.
    • Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager.
• Communication:
  • Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance.
  • Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues.
• Reporting:
  • Affords assistance in preparation of monthly denial reports and other denial reports as requested.
  • Affords assistance in preparation of monthly variance reports and other variance reports as requested.

Qualifications

• Education: High School Diploma or GED Equivalent or equivalent.

• Required Licenses and Certifications: Work Experience 1-3 years

• Work Experience: 1-3 years

• Skills: Knowledge Skills and Abilities

  • Ability to research, analyze and communicate payer trends to identify reimbursement and training issues; required
  • Excellent analytical and problem-solving skills
  • Good organizational and communication (written and verbal) skills
  • Excellent interpersonal skills
  • Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites; preferred

• Skills and Abilities: Professional and effective communication with third party carriers, vendors, and hospital contacts to promote contractual compliance and recommend corrective and preventative actions

• Must provide input and help design payer report cards in conjunction with contracting, managed care, and other revenue cycle departments

• Must participate as member of the Denials Committee

• Must conduct training sessions with Billing and Follow-up staff as needed

• Must have effective negotiating skills including the ability to resolve difficult claims issues

• Must be able to gather and share information with knowledge, tact, and diplomacy

• Must have extensive contact with: patients, payers, physician office staff, coding staff, Credentialing, Case Management, various Department heads, and all staff within the department

Physical Demands

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Standing: Constantly
• Walking: Frequently
• Sitting: Rarely
• Lifting/Carrying: Occasionally
• Pushing/Pulling: Frequently
• Climbing: Occasionally
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