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Full Job Description
Summary:
The Revenue Cycle Specialist is responsible for billing
and collecting payments. This position ensures that all accounts are
billed appropriately and meets all regulatory and compliance
requirements.
Role and Responsibilities:
Respond
to inquiries from insurance carriers, via telephone, email or fax and
demonstrate a high level of customer service.
Pursue
reimbursement from carriers by placing phone calls and documenting all
communication in Athenahealth to ensure progress is made on
outstanding accounts.
Identify and respond to patterns of denials
or trends and perform complex account investigation as needed to
achieve resolution.
Review and resolve uncollected accounts and
prepare charge corrections.
Appeal carrier denials through review
of coding, contracts, and medical records.
Call insurance
companies regarding any discrepancy in payments if necessary
Identify and bill secondary or tertiary insurances
Research and
appeal denied claims
Set up patient payment plans
Verify
patient benefit eligibility/coverage and research ICD-10 diagnosis and
CPT treatment codes as needed
Advise management of any trends
regarding insurance denials to identify problems with payers.
Complete required reports and assist with special projects as
assigned.
Essential Qualifications:
Education/experience: High School Diploma or General Education
Degree (GED) with 3 years prior hands-on experience in a fast-paced
medical billing environment. Must have previous experience in a
healthcare setting. Familiarity with CPT and ICD-10 is also required;
CPC certification is a plus.
Knowledge/Skills/Abilities:
Strong communication, including writing, speaking and active
listening
Great customer service skills, including interpersonal
conversation
Good problem-solving and critical thinking skills
Organization, time management and prioritization abilities
Ability to be discreet and maintain the security of patient or
customer information
Effective computer skills with practice
management software
Understanding of industry-specific policies,
such as HIPAA regulations for health care
Knowledge of insurance
guidelines, including HMO/PPO, Medicare, and state Medicaid
Knowledge of HMO/PPO, Medicare, Medicaid, and other payer
requirements and systems.
Effective communication abilities for
phone contacts with insurance payers to resolve issues
Customer
service skills for interacting with patients regarding medical claims
and payments, including communicating with patients and family
members
Able to work in a team environment
Problem-solving
skills to research and resolve discrepancies, denials, appeals
Knowledge of medical terminology
Knowledge of CPT/ICD-10 and
modifier coding
