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Revenue Specialist

4 months ago

Phoenix, United States Sonora Quest Full time
Job Description

Primary City/State:

Phoenix, Arizona

Department Name:

Billing Reimbursement

Work Shift:

Day

Job Category:

Revenue Cycle

POSITION SUMMARY
This position coordinates and facilitates all insurance claim submissions, claim rejections, account refunds, complex adjustments and collection activities. Also responsible for the posting of denial and non-payment Explanation of Benefits. The position will also participate in the review of all system set up requirements, billing guide-lines and fee reimbursements. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. 

CORE FUNCTIONS
1.  Responsible for the collection, submission and claim rejections for all assigned insurance accounts. Ensures all insurance payments and adjustments are posted in an accurate and timely manner in accordance with departmental policies, procedures and performance goals. 

2.  Responsible to utilize the Accounts Receivable Aging Reports, to track and maintain balances within acceptable range prescribed by management.

3.  Ensures all assigned insurance, regulatory and patient correspondence is researched, resolved and responded to in a timely, accurate and professional manner as defined in departmental policies and procedures. Communicates with insurance company personnel as needed to help facilitate the resolution of outstanding payment issues.

4.  Ensures that internal audits and quality controls are in place in accordance with departmental policies, procedures, generally accepted accounting practices and all applicable laws and regulations. Interprets and resolves written and phone correspondence involving bill transfers, adjustments, credit balances and refunds to facilitate prompt and accurate payments.

5.  Understands and implements the contractual requirements for billing to, and collecting from, assigned insurance carrier(s).

6.  Identifies and collaborates on improvements that can be made in the process of handling the insurance reimbursements area.

KNOWLEDGE/SKILLS/ABILITIES

  • Ability to clearly and efficiently communicate complex issues using strong verbal and written aptitude.
  • Extensive knowledge of billing, insurance, computer systems, and medical billing processes.  
  • Ability to prioritize and complete multiple tasks.
  • Ability to interact with all levels of personnel.

MINIMUM QUALIFICATIONS

  • Two (2) years’ medical claim collection experience with knowledge of insurance billing requirements and regulations. 
  • High School Diploma or equivalent.
  • Ability to work independently and accurately with high volumes of data and minimal supervision and be able to interface with difficult patients and/or third party insurance companies.
  • Excellent communication skills, both written and verbal.
  • Excellent organizational skills.
  • Beginner level experience of Microsoft Excel.

PREFERRED QUALIFICATIONS

  • Extensive knowledge of clinical laboratory operations.
  • Five (5) years’ of medical billing/insurance related experience.
  • Comprehensive knowledge of ICD-10 coding, CPT coding, HCPCS coding, modifiers, and government and commercial payer guidelines.
  • Advanced working knowledge of both the Xifin billing system and Microsoft Excel.

EOE/Female/Minority/Disability/Veterans

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