Revenue Cycle Transaction Specialist

About the role

Responsible for data entry related to medical billing from insurance companies (payors) and patients. Serves as a liaison between practices, clinics, the business office, payors, and patients. Maintains strict confidentiality for all patient accounts and follows approved processes, policies, and procedures.

Responsibilities

• Post patient and insurance transactions (charges, payments, adjustments, refunds) accurately and timely into the practice management system.
• Process patient and insurance refunds and issue refund checks to appropriate parties.
• Enter data into computer systems to maintain billing records and prepare insurance forms with details such as insurance company name, policy holder, policy number, and physician diagnosis.
• Contact insurance companies to verify patient coverage and obtain benefit information.
• Generate paperwork including insurance claim forms (original and re-filed) and collection letters; mail monthly statements to patients.
• Review insurance claim forms for accuracy, retrieving and attaching appropriate dictation as needed.
• Review insurance payments (Explanation of Benefits – EOBs), including Medicare and Medicaid payments, for accuracy in account information and demographics.
• Determine adjustments of claims paid at the out-of-network rate to in-network rates and process write-offs on these adjustments.
• Answer patients' questions regarding statements and insurance coverage; respond to inquiries from patients and payors via telephone or written requests.
• Follow up on unpaid insurance claims after denial to obtain settlement.
• Establish and maintain contacts with payor accounts’ representatives.
• Review accounts receivable activities and contact parties regarding outstanding balances or claims.
• Handle transactions necessary for discharged patients.
• Complete and file necessary paperwork for services rendered, including charge tickets, patient forms, and medical records.
• Adhere to all safety policies and procedures while supporting a culture of high quality and customer service.
• Perform other duties as necessary or in the best interest of the organization.