The Revenue Cycle Specialist/Analyst roll is to oversee the day to day processing of Medical Billing transactions to ensure that clients’ billing (accounts receivable) are processed in an effective, up to date and accurate manner. The Specialist/Analyst should understand medical billing processes and accounting, and should coordinate, monitor and handle a variety of data entry functions, maintain billing records and statistics, resolve data entry discrepancies, oversea and monitor claims submissions and resolve a variety of second level claim issues, overseas posting charges and accounts receivables. Provide analytical support in order to ensure effective and efficient operations of the team protocols.
As a key member of the team, the Revenue Cycle Specialist/Analyst will be responsible for all aspects of assigned clients claim cycle. This individual will maintain a consistent workflow for each client assigned in the RCM department. Ensure timely and proper payment from all payers. Follow up on outstanding claims and client issues. Identify and quickly rectify any issue that interrupts the clients Revenue Cycle.
RESPONSIBILITIES AND DUTIES
· Report directly to the Associate Manager on departmental issues.
· Monitor the capture and posting of patient billing charges.
· Identify issues resulting in non-payment of claims due to internal/external issues and rectify such issues in a timely manner and reports the issue to Associate Manager.
· Monitor the supporting documentation files. (electronic and paper)
· Verify accuracy of inputs by team members.
· Monitor daily claim submission, unpaid claims, and oversea the resubmission of claims as necessary
· Monitor the reconciliation of third party reimbursements to patients’ accounts in billing system
· Research and direct the team on denial resolution
· Process and work second level denial resolution
· Review and monitor aging reports with Associate Manager
· Answer second level billing and statement related phone calls
· Ensure strict confidentiality of finance and patient records
· Maintains strict patient confidentiality/HIPAA compliant.
· Maintain knowledge of ICD9/ICD10 diagnostic as well as CPT/HCPCS procedural coding.
· Maintain thorough knowledge of insurance carriers and their claim guidelines/requirements.
· Perform miscellaneous job-related duties as assigned
To be successful in this job an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and ability required.
- Experience: 4+ years’ experience in Medical Billing functions and procedures; supervisory experience of staff.
- Software Skills: Advance knowledge of MS Office Suite, esp. Excel; previous experience with Advance Data System billing software is a plus.
- Oral Communication: Speaks clearly, listens and gets clarification.
- Problem Solving: Identifies problems and communicates to management; resolves problems in a timely manner, works well in group problem solving situations.
- Quality: Must be organized and detail oriented. Demonstrates a commitment to accuracy and thoroughness in all responsibilities; seeks to improve the quality of work products and customer service. Comfortable monitoring and working from reports, spreadsheets and using technology to improve productivity and effectiveness.
- Electronic claim submission via Clearinghouse. Emdeon experience a plus.
- Billing for multiple specialties. Mental Health, laboratory and orthopedics billing experience a plus
- Experience with provider credentialing a plus.
- Billing for both Professional and Institutional claims with a solid understanding of HCFA-1500 and UB-04 claim forms as well as the electronic equivalent.
- ERA processing.
- EDI Enrollment.
Role: Revenue Cycle Specialist/Analyst (Medical Billing)
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