Job Description
Job Description
La Clínica del Pueblo Job Description
Job Title : Revenue Cycle Coordinator
Department : Finance
Supervisor : Patient Revenue Manager
Location : Hyattsville, MD
Classification : Salary / Exempt
Synopsis : Under the supervision of the Patient Revenue Manager, the Revenue Cycle Coordinator is responsible for preparing and submitting timely and accurate insurance claims to third-party payers using eClinicalWorks (eCW), verifying and posting payments and adjustments, managing aging reports, and following up on denied or underpaid claims. The Revenue Cycle Coordinator also plays a critical role in assisting with payer enrollments for all providers, ensuring credentialing documentation is complete and submitted in a timely manner, and maintaining compliance with FQHC and payer-specific requirements. This role requires a high level of attention to detail, the ability to work independently, and in coordination with La Clínica’s staff and contractors.
Qualifications : Required Education and Experience :
- High school diploma or equivalent required.
- Understanding of payer EOBs / Remits.
- Strong computer skills including Microsoft Word, Excel
- Minimum of 2-3 years of experience using ICD-10, HCPCs, CPT, medical coding and billing.
- Minimum of 2-3 years of experience in a revenue cycle billing position (Experience with medical billing, patient registration, or insurance verification).
- Experience using electronic medical records (EMR); eCW preferred.
- Excellent oral, written, and telephone communication.
- Working knowledge of rules and regulations pertaining to the FQHC guidelines.
- Ability to prioritize and manage multiple tasks with efficiency in dealing with multiple facilities, departments and programs.
- Ability to handle a large volume of project receiving, submitting and researching claims.
- Ability to work independently with minimum supervision in a team-oriented environment and interrelates well with individuals with diverse ethnic and cultural backgrounds and needs.
Preferred Education and Experience
eCW experience preferred.Registration / intake experience preferred.Payer enrollment experience preferred.Knowledge of medical terminology and practicesDuties and Responsibilities :
Prepares and submits clean claims to various insurance companies either electronically or paper.Reviews and posts denials to accounts according to the EOB to ensure accurate payment status and account activity.Reviews and assigns claims that need provider attention via jellybeans in eCW to appropriate staff.Prepares bank reconciliation log daily to report incoming insurance checks / depositsMonitors aging reports and takes necessary actions to guarantee payments of claims.Reviews accounts daily and makes phone calls or checks insurance portals to assigned insurance groups for insurance follow-up to determine claim adjudication.Assures compliance with applicable billing laws and regulations to maximize cash receipts.Contacts insurance carriers regarding non-payments and / or improper payment on claims.Identifies problem accounts with payers; investigates and correct errorsFollows-up on missing account information and resolves past-due accounts.Prepares reports to identify and resolve accounts receivable.Helps with year-end reports such as patient revenue reports, adjustments, aging report, charity care, etcPosts patient payments to accounts and applies payment to claims.Posts ERA payments, adjustments, and write offs to appropriate accounts.Prepares, reviews, and sends patient statements.Reviews Telephone Encounters assigned for patient account follow up.Answers inquires by phone regarding past-due accounts and insurance guidelines.Transfers bills to secondary or tertiary accounts, if applicable.Makes adjustment to either patient or practice accounts based on internal reports and / or documentation.Responsible for reading and understanding various types of Explanation of Benefits.Keeps supervisor informed of areas of concern and problems identified.Assists in the preparation of monthly reports to ensure accuracy and timely processing of claims billed through the EMR.Prepares and distributes monthly Unlocked Encounters Report to ensure all visits are locked and ready to bill for the month.Assists with preparing and submitting provider enrollment and revalidation applications to commercial and government payers (e.g., Medicare, Medicaid, MCOs).Assists with enrollment application status and follow up with payers to ensure timely processing.Assists with maintaining accurate and current enrollment records, rosters, and CAQH profiles.Assists with updating and maintaining provider and organizational information in payer portals and directories.Maintains strict confidentiality regarding confidential conversations, documents, and files.Participates in educational activities and attends monthly staff meetings.Adheres to all HIPAA guidelines / regulationsPerform other related duties as assignedPhysical Requirements :
Prolonged periods of sitting at a desk and working on a computerMust be able to lift up to 15 pounds at timesSupervisory Responsibilities : None