Revenue Cycle Specialist

Position Summary : The

Revenue Cycle Specialist is responsible for the accurate and timely submission of medical claims to insurance companies and other payors. The medical biller posts payments or adjudications as appropriate. Using knowledge of billing practices and standards including third party payor requirements, the medical biller will investigate denials to process appeals and collect payment.  In addition, this position is responsible for reviewing coding for outpatient services for reimbursement and research compliance.

Supervision : Director of Health Information Management

Medical Billing :

• Performs claim review, verifies accuracy and completeness of all required information to perform submission to Medicare, Medicaid, commercial and private insurance payers
• Applies payments and adjustments to patient accounts.
• Review explanations of benefits for correct adjudication and payment according to applicable managed care contract terms and reimbursement.
• Review of unpaid claims, researching denials and / or lack of activity to ensure timely payment and maintain cash flow.
• Follow up with insurance payers for processing appeals and errors.
• Receive and resolve inquiries, concerns, or complaints related to patient accounts from patients, insurance carriers, employers, etc.
• Provide customer service and interact with clinicians, managers, and clients as needed to resolve outstanding items.
• Responsible for resolution and appropriate refunding of credit balances, denied claims, and charges on hold. Includes working credit balance reports as needed.
• Meet productivity and quality assurance benchmarks.

Coding :

Job Skills :

Training and Education

Associate degree and / or Diploma in medical coding and billing or credentialed in medical coding and billing required.

Work Experience

Employee Charge to NOVUS Mission :

Candidates should be aware of NOVUS Health strong commitment to diversity and inclusion. With a focus on providing trauma informed, holistic health we expect all staff to meet patients, community partners, and co-workers with respect and dignity. We challenge each other to acknowledge biases that exist in healthcare, including racial, gender, gender identity, sexual orientation, ethnicity, and / or personnel beliefs. We look for ways to eliminate these biases at all points of services and care. Together as a team member of NOVUS, we will begin to break down barriers, build access, and create healthier communities.