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Revenue Cycle Specialist

1 month ago

Doral, United States ConsultNet Full time

Job Summary
The primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee adherence to both external and internal deadlines, ensuring the prompt processing and resolution of open claims. The objective is to conclusively settle all claims within the designated timely submission period. This role also includes overseeing billing procedures, identifying and communicating trends and patterns to relevant stakeholders, and accurately applying contractual obligations and service level agreements during billing operations.

Duties & Responsibilities:

  • Conduct root cause analysis for systemic issues related to adjudicated claims impacting upstream billing to health plans, and follow up with internal and external parties to address reasons for denial.
  • Demonstrate knowledge of insurance regulations, payment policies/guidelines, and effectively communicate with payers to resolve and accurately pay claims.
  • Review payer 277/277CA and 835 responses and adjust claims accordingly.
  • Accurately review patient demographic and insurance data in the proprietary billing system concerning covered services and areas.
  • File and track the progress of appeals and reconsiderations of claim decisions by assigned payer(s).
  • Identify and communicate trends and patterns that indicate deficiencies in the revenue cycle process, requiring multi-department collaboration and/or systematic development.
  • Serve as the point of contact for all inquiries from health plans, providing superior customer service and effectively communicating with insurance companies to determine claim status and specific claim dispositions.
  • Maintain the strictest confidentiality; adhere to all HIPAA (Health Insurance Portability and Accountability) and other industry rules and regulations.

Requirements:

  • College education in health services administration, accounting, business, or similar discipline, or equivalent experience.
  • Knowledge of medical billing and coding.
  • Certified Coding Specialist (CCS), Certified Coder Associate (CCA), or AAPC - CPC Certified Professional Coder is desirable.
  • Minimum of 1 year experience in end-to-end revenue cycle management.
  • Experience with clearinghouse platforms and RCM systems, preferably Waystar, Optum, and Availity.
  • Experience working independently and as a member of various teams and/or workgroups.
  • Strong computer skills and knowledge of MS Office products with intermediate Excel level.
  • Ability to quickly navigate between different system platforms.
  • Strong written and verbal communication skills.
  • Strong organizational, problem-solving, and analytical skills.
  • Acute attention to detail.
  • Bilingual (English/Spanish) is desirable.



Welcome to ConsultNet and the family of companies, Tekne, SaltClick, TechBridge, and OmniMedia. As a premier national provider of technology talent and solutions, our expertise spans across project services, contract-to-hire, direct placement, and managed services both onshore and nearshore.

Celebrating more than 25 years of partnership with a diverse client base, we've crafted rewarding opportunities for our consultants, fostering high-performing teams that deliver impactful results.

Over the last few years thousands of consultants have found their calling with us in roles that have made a meaningful impact on their lives, enhanced their career, challenged them, and propelled them towards achieving their personal and professional goals. At the ConsultNet family of companies, we believe effective communication is crucial in aligning the right job with your unique skills and professional aspirations. To us, it's all about the personal approach we take and the values we uphold.

Our comprehensive service offerings cover a wide range of technology positions across key markets nationwide. Client more at www.consultnet.com.

We champion equality and inclusivity, proudly supporting an Equal Opportunity Employer policy. We welcome applicants regardless of Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other status protected by law.