Revenue Cycle Specialist

Job Summary

The Revenue Cycle Specialist position is responsible for the full revenue cycle processes including, but not limited to billing, collections, appeals and payment posting. This position is primarily responsible for entering all physician and facility charges as well as posting payments and collections. The individual will need to complete position responsibilities by following established guidelines and protocols within the appropriate time frame, and must be flexible with his / her work schedule. This position involves discretion and independent action within prescribed limits.

Responsibilities

• Validate both facility and physician claim for all billable patients in system.
• Validate all pertinent billing information on all UB and HCFA in order to submit clean claims.
• Cross reference Physician Name and Dates of Service with the Financial Log for accuracy on all UB and HCFA claims.
• Cross reference all CPT, HCPCS and Diagnosis codes with the coding sheet for accuracy on all UB and HCFA claims.
• Ensure all patient demographics and payer information (address and / or payer ID info) are accurate for claims submission.
• Verify Insurance and make patient calls as needed.
• Submit all UB and HCFA claims to clearing house and work rejections, if needed.
• Run Daily Claims Report to ensure everything was billed.
• Bill Secondary claims with Primary EOB.
• Process Front End Rejections Daily.
• Work and resubmit corrected claims as needed.
• Document Accounts.
• Identify and Report trends as needed.
• Promote patient loyalty and retention through quality customer service and quick resolutions.
• Ensure delivery of excellent customer service through communication, and coordinating with other departments to resolve issues.
• Complies with all applicable policies and procedures to meet JCAHO and company standards.
• Receives the denied claims and researches appropriate appeal steps.
• Communicates directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc. and also using appropriate reports and working queues.
• Tracks and documents all denials by payor, visit type and denial category.
• Under the direction of leadership works with necessary departments in order to drive process improvement and system edits.
• Works with the payors to understand specific reasons for denials and preventable measures available to prohibit future denials.
• Ensure that all patient accounts are properly and completely documented with the department's documentation requirements established by management.

Qualifications

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to stand; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to walk; climb or balance; and stoop, kneel, crouch, or crawl. The employee must frequently lift and / or move up to 10 pounds and occasionally lift and / or move up to 25 pounds. Specific vision abilities required by this job include close vision, and ability to adjust focus.

Work Environment

A fast-paced, high performance work environment. The noise level in the work environment is usually moderate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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