Revenue Cycle Representative

4 weeks ago

East Saint Louis, United States So IL Health Care Foundation Full time
Job DescriptionJob Description

VISION, MISSION, PLEDGE & VALUES:

Every employee of SIHF Healthcare is expected to uphold our vision, mission, pledge, and values. Our actions will reflect our values of service, diversity, integrity, excellence, and teamwork. We pledge to collectively reflect our values each and every day in the pursuit of better health and lives of those we serve, work with, and live among. This will result in our vision of people achieving their highest quality of life through the fulfillment of our mission to lead individuals and communities to their healthiest lifestyle by providing a coordinated network of health and supportive services.

CUSTOMER SERVICE COMPLIANCE STATEMENT:

Treat every person with dignity, respect, and kindness by listening with your full attention, address questions/concerns immediately, and accept responsibility to follow through by always doing what you say you will do. You support our customers, and your team, by being patient, understanding and positive, knowing that you are SIHF Healthcare to those we serve.

POSITION DESCRIPTION:

Responsible for ensuring team performance that supports the mission of SIHF Healthcare and facilitates the achievement of health center or department goals and objectives. Administer the functions within the department including but not limited to complete aging report according to department regulations, including manager holds, holds, kick codes, fully worked and overpaid flags.

ESSENTIAL DUTIES AND RESPONSIBILITIES:Review and approve charges to be submitted to the correct third-party payer.

  1. Evaluate outstanding accounts receivable as assigned by leadership team.
  2. Follow up with third party payers using provider portals and/or telephone calls to drive correct processing of claims submitted.
  3. Interact with management, SIHF leadership, and health center staff to resolve customer or payer issues and/or concerns.
  4. Develop relationships with carrier representatives to resolve complex issues.
  5. Identify and report rejection trends to department leadership
  6. Research solutions and make recommendations to department leadership.
  7. Verify patient third party payer eligibility information.
  8. Identify potential coding errors and work with site managers or other team members to resolve.
  9. Set a good example for team members in the area of professionalism, customer service, and adherence to SIHF Healthcare policies and procedures.
  10. Always provide excellent customer service to patients, clients, other RCM team members, and all the SIHF Healthcare team members.
  11. Perform routine duties with minimal supervision.
  12. Be a resource for all health center staff to understand their role in the claim submission process
  13. Must be HIPAA compliant and maintain confidentiality of all health records.
  14. Other duties as assigned.

KNOWLEDGE, SKILLS, ABILITIES:


  1. Must have well developed oral and written communication skills with the ability to read and comprehend simple instructions, write short simple correspondence, and memos.
  2. Ability to effectively present information in small groups and one-on-one situations to customers, clients, and/or other employees of the organization.
  3. Proficient personal computer skills including electronic mail, record keeping, routine database activity, word processing, spreadsheet, graphics, etc.
  4. Ability to handle multiple tasks and prioritize.
  5. Requires the ability to maintain confidentiality.
  6. Knowledge of Medicaid, Medicare, FQHC, Commercial, Work Comp and all other third-party payer billing guidelines.

EDUCATION AND EXPERIENCE:

High school diploma or GED and one (1) year related experience preferred. An understanding of billing rules and regulation related to Medicaid, Medicare, private insurance, and self-pay physician services is desired.

PHYSICAL DEMANDS:

Sedentary physical activity performing non-strenuous daily activities of an administrative nature

WORK SCHEDULE:

Normal work hours for this position are Monday through Friday dayshift. Occasionally, weekends and/or overtime is required.

COMPLIANCE STATEMENT:

Abide by the requirements all applicable State and Federal laws.

MEDICAL HOME STATEMENT:

Be aware and understand expectations and responsibilities of the Patient Centered Medical Home. Understand role, complete relevant duties, and the requirement to maintain highest level of proficiency within scope, as part of this team-based approach in the patient care continuum.


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