Revenue Cycle Associate I

Job Description

Job Description

Primary Purpose of the Position :

The Revenue Cycle Associate I is responsible for working on accounts to maximize cash collected. Position also performs a variety of duties which may include answering incoming telephone calls, documenting insurance information, verifying eligibility, and billing / appealing claims to the various insurance carriers. This position is responsible for handling patient accounts in a high-performance team environment with a number of additional duties as needed for operational needs.

Essential Duties of the Position May Include the Following :

• Reviews claims to ensure all key components were submitted accurately to the correct payer.
• Reviews correspondence and denial information to determine why claims have not been paid and takes appropriate actions to ensure the accurate and timely submission of claims.
• Researches and analyzes accounts and payments to determine whether charges were billed properly, and to resolve incorrect information on patient accounts; reverses balance to credit or debit if charges were improperly billed.
• Corrects and resubmits claims and identifies issues that require attention. Makes all the appropriate corrections in the system and submits appeals as appropriate, following individual payer guidelines and including all supporting documentation.
• Contacts insurance companies and or patient / guarantor to verify insurance eligibility and resolve payment problems; provides information to expedite the collection process.
• Prepares adjustments for charges that cannot be billed and processes or submits to the supervisor per adjustment guidelines.
• Ensures authorization, TARs / SARs are included in claim submissions to payers, and follows appropriate steps to secure the authorization / retro authorization.
• Consistently meets productivity and quality standards.

Job Qualifications :

Knowledge and skill :

1.      At least two (2) years’ healthcare experience in customer service, exposure to payer authorization requirements, post-billing denials, insurance verification or intermediate-level collector experience preferred.

2.      Ability to communicate effectively in both written and verbal formats with internal and external customers.

3.      Ability to handle multiple tasks simultaneously.

4.      Familiarity with payer billing and reimbursement guidelines & regulations, including ability to read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD). Working knowledge of Medi-Cal and CCS Preferred.

5.      Working knowledge of ICD-10.

6.      Ability to determine correct claim processing related to payer recoupments, overpayments / credits / refunds & underpayments.

7.      Ability to organize and manage time effectively.

8.      Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA & PHI guidelines.

9.      Ability to work independently and as a part of a larger team.

10.  Microsoft Word, Outlook & Excel knowledge.

11.  Highly customer-centric position with strong customer service abilities

12.  Bilingual in Spanish is preferred but not required.

Company Description

Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.

Company Description

Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.