Job Summary:
Primary job duties are billing including resolution of any issue preventing the claim from billing, claim follow up, denial management including appeals, timely and accurate posting and adjustments, obtaining prior authorizations, patient collections, and resolving patient billing issues. The Revenue Cycle Specialist will be primarily focused on specific revenue cycle functions as assigned by their Director. This role is part of the Revenue Cycle Team and will be cross trained to perform the various revenue cycle functions as needed to meet business needs.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.
- Verify and understand insurance coverage information and update appropriately.
- Utilize eligibility systems to verify coverage, such as eligibility and payor platform portals or directly contacting payors.
- Revise insurance information for required updates on existing patients.
- Call, fax, or enter via a patient portal information needed for prior authorization.
- Routinely discuss financial obligations with patients and/or providers, including contacting patients to collect money.
- Inform relevant staff about the root cause of denials and/or billing and reimbursement.
- Assist with answering billing and benefits related questions.
- Understand the claims process from creation to submission in the Genomind/Telcor system (once trained).
- Resolve claim rejections.
- Denial management and claim follow up including submitting appeals.
- Maintain AR days at or below the established goal.
- Maintain the collection percentage at or above the established goal.
- Assist with training and mentoring new team members as needed.
- Routine reporting.
- Communicates complaints concerning service failures to designated department manager(s) for investigation and follows through on specific incidents if applicable.
- Examines pertinent information to determine accuracy of customer requests and related paperwork.
- Assumes other duties as assigned by management.
- Understands and observes all confidentiality and HIPAA provisions.
- Responsible for all equipment in assigned areas of work.
- Must always obey all safety rules and regulations.
Education
: High School or equivalent
Experience:
At least 2 years medical billing or denial management or prior authorization experience.Previous experience in a medical/lab business office or with a revenue cycle management vendor.Medical terminology.Competencies Needed:
- Effective communication skills and excellent interpersonal skills are essential; proficient written communication is critical.
- Experience in building and maintaining strategic relationships with customers.
- Proven multi-tasking and project planning skills; the capacity to work in a fast-paced environment, and the ability to contribute creative yet practical solutions to problems.
- Must show good judgment and convey professionalism when dealing with clients and challenging situations.
- Must be detail oriented, independent worker, dedicated and goal oriented with ability to meet deadlines.
- Flexibility/Adaptability to manage working in a growth stage company environment.
- Ability to build new processes and learn new skills quickly.
- Proficient in Microsoft Office Platforms; experience using CRM tools; Salesforce preferred.
- Ability to de-escalate a call with a patient and/or provider in a professional and customer friendly manner.
- Ability to discuss financial concerns and adhere to company collection policies in a professional and customer friendly manner.
- Familiarity with clearinghouses, payer portals, prior authorizations, appeals, and denial management.
- Understand reimbursement methodologies.
- Key understanding of the differences between Medicare, Medicaid, and Commercial insurance plans in relation to billing and reimbursement.
- Ability to read and interpret payer remittances and explanation of benefits.
- Basic understanding of cash posting principles.
Working Conditions:
General office setting with modern equipment. Must possess visual and audio skills and excellent verbal and written communication skills to complete above listed duties. Must be able to sit ninety (90%) of scheduled work hours. Must be able to reach and stretch as necessary for typing, answering phone calls, taking notes, and completing paperwork.
Physical Requirement:
The Physical Requirements described herein are representative of those which must be met by an employee to successfully perform the primary functions of this job. Reasonable accommodation may be made to enable individuals with disabilities who are otherwise qualified to perform the primary functions.
Job Classification:
Remote Monday thru Friday Non-Exempt
Preferred but not Required.
Bilingual, Spanish/ English
