Revenue Specialist

This position reports directly to Senior Revenue Analyst. The Revenue Specialist performs a variety of tasks associated with billing and collections of open Accounts Receivable and provides quality customer services to each bureau regarding third party billing issues. Responsibilities include but are not limited to the following :

• Manage daily, weekly, and monthly submissions of claims to the third-party payers including corrections and appeals.
• Bill per diem and ancillary charges such as Residential and mental health to appropriate payors, meeting all government and third-party regulations.
• Approve claim submissions and batching for each program to payers and upload batches to Virtual gateway
• Refile claims edits using Change Health Care / Emdeon portal.
• Review CARC code denials and submit appeals to health insurance within the insurance filing period and provide feedback to Senior Revenue Analyst and Director on how these claims were resolved.
• Contact payers for OFFSET information to post the zero-pay remit.
• Post 835 Files and manual post remits from payers and ensure entries are recorded accurately.
• Monitor balances to ensure claim should be appealed or proper contractual adjustments or write off posted.
• Work closely with programs on resolving any issues regarding claims and clients.
• Review Authorizations with programs and payers.
• Review client enrollments and re-enrollments prior to submission of claims.
• Work with Account Receivable Specialist to ensure EFT payments were received prior to posting payments and keep a log of payments that were received.
• Research payments that are unapplied or mis-posted using Lockbox / Payspan or third-party web portals
• Run Eligibility using NEHEN, MMIS and other portals and update Carelogic if insurance has changed and notify programs for possible authorization.
• Be able to effectively handle multiple tasks at one time.
• Understand and maintain patient confidentiality.
• Operate out of multiple systems as assigned (billing system , payer portals, emails etc.) and work in a team environment.
• Contact health insurance carriers for explanation of denials as well as appeal status and answer incoming calls.
• Assist with the preparation of information needed for any audits i.e., 835, 837 etc.
• Manage yearly CPT / Modifier code additions / changes related to third party billing and yearly notifications from health insurance carriers regarding authorizations.
• Collaborate with other members within Finance and all the Bureaus across the Boston Public Health Commission.
• Cross Train within the Finance Department to promote team building and professional development.
• Assigned special projects and other duties as needed.

MINIMUM QUALIFICATIONS :