Revenue Cycle Specialist

Responsibilities

• Monitor held billing and coordinate resolution of related issues to ensure timely claim submission
• Review, research, and correct claims that fail payer edits; update payer information and resubmit claims within the EMR system as needed
• Understand and actively follow up on outstanding accounts receivable to minimize aging
• Work all assigned and denied claims promptly and accurately
• Assist in preparing and submitting appeals and reconsiderations to payers
• Collaborate with internal teams (billing, authorizations, clinical, etc.) to resolve billing and collections issues
• Communicate with payers to obtain claim status and resolve outstanding balances
• Maintain accurate documentation of collection activities and provide updates and reports on collection efforts as requested
• Assist with special projects, audits, or process improvement initiatives as assigned
• Identify trends related to denials/coding and delinquent claims and communicate effectively with client manager for feedback to the client
• Identify system/payer issues such as rates, codes, setup and coordinate accordingly
• Report status of accounts and issues to appropriate supervisors and departments – always maintain full transparency of accounts
• Follow requirements through the full cycle until accounts are satisfied, including patient collections and appeals
• Document, process, and coordinate all write-offs and adjustments as needed
• Work with contracting team and management to resolve payer issues
• Work with branches for all questions on accounts
• Attend regular meetings with teams and management to ensure open communication
• Perform other duties as assigned

Requirements

• Excellent verbal, written, and computer communication skills
• Able to communicate across all levels of authority within the company
• Excellent organization, problem-solving, and project/time management skills
• Able to work with multiple teams within the organization to promote viable, ethical, and cost-effective solutions
• Proven track record of successful collections
• Able to effectively deal with change
• Able to complete projects within specific timetables
• Able to successfully interact with people in face-to-face situations as well as by telephone in a professional and effective manner
• Satisfactory background screens as required by State, Federal, and Company policy free of any OIG sanctions