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Revenue Cycle Specialist
2 months ago
Overview
Revenue cycle specialist is an account receivables and billing expert who will perform necessary tasks for revenue cycle management including but not limited to claims management, A/R and denials follow-up and resolution, payment posting and collections management, Payer enrollment/credentialing and privileges, Authorization management.
Key Role Responsibilities
- Perform a variety of RCM functions such as charge and payment posting, obtaining and tracking authorizations, processing of electronic EDI claims and electronic Explanation of Benefits (EOBs), follow-up on outstanding or denied claims, receivable management tracking and reporting, credentialing and privileging
- Responsible for accurate and timely insurance claims follow-up and accounts receivable resolution with payers including appeals and submission of corrected claims
- Accountable for aged claims and special accounts receivable projects
- Adhere to government regulations, payer contracts and insurance guidelines when performing insurance follow-up, resolving open accounts and appealing claims
- Be a key contributor to the Revenue Cycle by identifying and reporting inefficiencies and opportunities that enhance revenue flow, decrease denials and minimize write-offs
- Respects and adheres to rules and regulations regarding patient confidentiality, HIPAA, and handling PHI (Privileged Health Information)
Skills Requirements
- Exceptional detail orientation, critical thinking, analytical and problem-solving skills
- Proficiency in government, commercial and/or insurance payer claims follow-up, denial resolution and appeals processes
- Ability to interpret and apply insurance payer billing guidelines, claim rules and contract terms
- Knowledge of CPT and ICD coding systems
- Ability to collaborate and work cohesively as part of a team
- Strong communication skills, both written and verbal
- Excellent interpersonal and customer service skills to interact and maintain relationships with a wide range of personalities
- Strong organizational skills necessary with strong accountability and drive
- Demonstrated proficiency with databases and spreadsheets
- Able to cope with interruptions, be flexible, and be a team player
Key Agency Responsibilities
In addition to role responsibilities, every staff member has the following responsibilities as a part of their employment:
- Models and reinforces the core values of dignity, authenticity, hope, justice, passion and balance
- Actively participates in performance improvement and advocacy activities that support the mission
- Protects clients’ personal health information by maintaining compliance with HIPAA and other relevant health care-related IT security regulations
- Performs other duties on an as-needed basis
Knowledge, Experience, and Skills
Formal Education and Training
- Associate’s degree or equivalent experience
- Certified Professional Coder (CPC) certification preferred
Experience
- Two years or more revenue cycle experience in a health care setting required
- Experience in and knowledge of Medicare/Medicaid/Commercial payer guidelines
- Experience with Athena Practice Management would be a plus.
- Familiarity with insurance verifications and prior authorizations is preferred
- Experience working in a federally qualified health clinic (FQHC) is highly desirable
- Comfortable working with homeless and/or low-income individuals and families
Health Care for the Homeless is an equal opportunity employer and is committed to racial equity and inclusion. We make a particular effort to recruit and promote Black, Indigenous and People of Color (BIPOC) for open positions. BIPOC, LGBTQIA+ individuals, people with disabilities, and people with other marginalized identities are encouraged to apply.
This is a "flexible" position: At least 50% of position will be remote. General telework location must be within reasonable driving distance of our Baltimore-based offices
