Revenue Cycle Management Aging Specialist

3 weeks ago

Vancouver, United States Lifeline Connections Full time
Job DescriptionJob Description

Our Vision

As the premier provider of substance use and mental health services in the Pacific Northwest, we are respected and the most trusted resource for behavioral health treatment and whole person care. We provide a comprehensive continuum of coordinated quality services, foster enduring relationships, and empower our communities to truly thrive.

Our Mission

Through superior customer service, high quality programs, and a well-trained and dedicated staff, we inspire hope and support lifesaving changes for people affected by substance use and mental health conditions.

Salary: $19.25-$20.25 per hour


MAJOR DUTIES: The RCM Aging Specialist position works under the supervision of the RCM Manager. This position ensures acceptable reimbursement and appropriate days in Accounts Receivables with timely account follow-up and resolution of outstanding charges owed by third party payers using accepted billing practices to ensure thorough and consistent account resolution to promote financial health. They help support and train lower level staff. In fulfilling these duties, the incumbent performs the following duties independently:

  • Verifies patient eligibility and/or benefits via telephone or website, follows up with patient and health plan to determine that the patient is covered and documents findings in the ECR.
  • Provides outstanding customer service to patients and staff via answering calls and emails to the billing office in a timely, accurate manner, and completing documentation in the ECR, if applicable.
  • Assists patient in applying for and then approving them for a Sliding Scale or other available funding, notifies the patient, and enters the information into the ECR.
  • Assist people in receiving services and families to access benefits, including Medicaid, and enroll in programs that may benefit them.
  • Provide patients access to WA Apple Health BH Services Booklet. Apple Health client booklets | Washington State Health Care Authority
  • Accurately completes treatment cost estimate forms and payment agreements for patients and documents in the ECR.
  • Responsible for running and maintaining daily account / follow-up reports over 90 days while maintaining organization’s productivity standards.
  • Identifies potential trends in denials/reimbursement by payer or by type, denial reason, or coding issue and reports to supervisory staff for appropriate escalation;
  • Maintains open and effective communication with payer provider representatives to assist in large scale denials/reimbursements;
  • Reviews insurance remittance advices, researching denial reasons and resolving issues through well-written appeals;
  • Conducts follow-up process activities through phone calls, online processing, fax, and written correspondence.
  • Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have a potential impact on revenues.
  • Complete account audits as needed.
  • Reviews self-pay claims to determine if a payer or funding can be entered, or confirming the claims are indeed self-pay.
  • Reviews accounts for patient charges and prepares for statement processing.
  • Runs statements and processes them for sending electronically.
  • Contacts patients for payment requests, overdue payments, denied claims and arrange payment plans.
  • Responsible for identifying, researching, and resolving credit balances, missing payments, and unposted cash as it pertains to billing account follow-up.
  • Respond to and submit refund requests.
  • Reviews patient accounts for referral to Third-Party Collections, prepares the Third-Party Collections report, and submits account to Third-Party Collections.
  • Communicates effectively with payer customer service representatives and maintains professional communication with team members to support denials resolution.
  • Prioritize tasks to meet multiple deadlines and productivity requirements.
  • Complete training and attend weekly staff and other meetings.
  • Complete the training for Apple Health/Medical insurance. Community-based training | Washington State Health Care Authority
  • Can work independently without assistance.
  • Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation;
  • Maintains strictest confidentiality; adheres to 42 CFR part 2 and all HIPAA guidelines/regulations;
  • Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function;
  • Establishes and maintains professional and effective relationships with peers and other stakeholders;
  • Will work as part of a billing team;
  • Supports and implements agency policies and procedures.
  • Performs special projects as assigned by supervisor;

KNOWLEDGE AND SKILLS REQUIRED BY THE POSITION

  • Possess three to five years’ experience in medical/non-profit billing using electronic health records, clearinghouse, and electronic claims and payments, customer service, and payment collections.
  • Requires a detailed understanding of insurance billing, Medicaid billing in Provider One, ICD-10/CPT codes, HCFA 1500, UB-04 and an understanding of insurance requirements for payment;
  • Medical Billing and Coding Degree preferred;
  • Prior experience with Qualifacts’ CareLogic electronic health record preferred;
  • Ability to produce accurate information and reports using Microsoft Excel advanced skills;
  • Ability to communicate clearly and effectively;
  • Great attendance;
  • Collaborative: Ability to work well with others.
  • Must be highly organized, detail oriented, possess good analytical skills, effective verbal and written communication skills, and be able to work well under pressure.

GUIDELINES

Requires that the incumbent relies on specialized training and/or equivalent experience and performs duties in accordance with Washington Administrative Codes, Federal regulations governing the confidentiality of patient files, and Lifeline Connections Policy and Procedure Manual.

PERSONAL CONTACTS

Contacts are with the members of the treatment team, consumers, significant others of the consumers, representatives of various community agencies specializing in the treatment of chemical abuse and mental illness. All personal contacts are carried out in accordance with federal and state laws dealing with the confidentiality of patient records.

PHYSICAL DEMANDS

While performing the essential functions of the job, the employee is regularly required to sit, speak clearly, hear, and use hands and fingers to manipulate writing utensils and keys on a keyboard.

WORKING ENVIRONMENT

Working hours are spent indoors in offices or other meeting rooms. Participation in staff retreats and staff development activities will be required.

IMMEDIATE SUPERVISOR: Revenue Cycle Manager

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