Revenue Cycle Specialist II (Physician Billing)

About the role

Provides Commercial and Government billing and collections support to Insurance Follow up and Accounts Receivable, performing duties which may include reviewing and submitting multi-specialty claims to third party payors, performing account follow-up activities, updating patient registration on accounts, etc.

Responsibilities

• Reviews and submits multi-specialty claims to third party payors
• Performs account follow-up activities
• Updates patient registration on accounts
• Researches and analyzes complex cases and problem accounts with minimal assistance
• Serves as a technical resource (subject matter expert) to others and may act in the absence of the lead and/or supervisor
• Bills, submits appeals, and collects monies relative to physician reimbursements
• Maintains and processes accounts that are straightforward or may need further research
• Works in a team environment to fulfill the mission and goals of the Department

Requirements

• High school diploma or GED
• Ability to read, write, understand and speak English effectively
• Minimum of three years professional/physician billing and/or Collection experience – CMS1500 experience a plus
• Expert knowledge and understanding of regulatory requirements, payor contracts and CSHS policies governing billing and collections and sound interpretation of same
• Extensive knowledge of insurance carrier procedures
• Experience with reading Explanation of Benefits (EOB) statements
• Expert knowledge of medical terminology and coding (ICD, CPT, HCPCS, Modifiers, procedure, bill type, diagnosis, and revenue codes)
• Experience with MS Office, Web/Vs, Availity And CS-Link
• Basic understanding of HIPAA and other privacy information guidelines
• Perform business math
• Successful completion of PRMPT 1
• Ability to handle multiple tasks in a fast paced and high-volume environment with conflicting demands on time and attention
• Ability to prioritize and organize work to complete assignments in a timely, accurate manner
• Minimum 3 years’ experience in Commercial and Government billing and follow up
• Office visits, procedures, outpatient and inpatient preferred
• Ability to interpret regulations for Commercial Ins, CMS or Medi-Cal
• Professional and courteous demeanor