Revenue Cycle Specialist

2 weeks ago

Miami, United States Alivi Full time
Job DescriptionJob DescriptionSUMMARYThe primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to conclusively settle all claims within the designated timely submission period. This encompasses but is not limited to, overseeing the coordination of billing procedures and conveying identified trends and patterns to relevant stakeholders while accurately applying contractual obligations and service level agreements during the execution of billing operations.DUTIES & RESPONSIBILITIES
  • Identifies and performs a root cause analysis for any systemic issues associated with adjudicated claims that may impact upstream billing to the health plans and provides follow-up with internal and external parties as applicable to address reasons for denial.
  • Demonstrates knowledge of insurance regulations and policies, payment policies/guidelines, and the ability to communicate and work with payers to get claims resolved and paid accurately.
  • Review payer 277/277CA and 835 responses and adjust the claim accordingly. 
  • Accurately and efficiently review patient demographic and insurance data in our proprietary billing system as it relates to covered services and areas. 
  • Files and tracks the progress of appeals and reconsiderations of claim decisions by assigned payer(s).
  • Identifies and communicates trends and patterns that reflect deficiencies in the revenue cycle process that require multi-department collaboration and/or systematic development.
  • Serve as the point of contact for all inquiries from health plans, while providing superior customer service and effectively communicating with insurance companies to ascertain 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)/AAPC - CPC Certified Professional Coder 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 skills, problem-solving, and analytical skills. 
  • Acute attention to detail.
  • Bilingual (English/Spanish) is desirable. 
 COMPETENCIES
  • Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification before acting; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. Writes clearly and informatively, Edits work for spelling and grammar.
  • Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
  • Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
  • Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
  •  

Powered by JazzHR

7fOpmrQmU6

  • Revenue Cycle Specialist

    5 days ago

    Miami, United States Firstsource Solution USA Full time

    Location: REMOTE- Revenue Cycle Billing Hours: Monday through Friday 8:00am - 5:00p **GENERAL SUMMARY**: The goal of the Revenue Cycle Billing Specialist is to successfully collect on aging medical insurance claims. **Essential Duties and Responsibilities**: - File claims using all appropriate forms and attachments. - Handle Outbound calls and Maneuver...

  • Sr. Revenue Cycle Audit Specialist

    5 days ago

    Miami, Florida, United States UOMUOMUS Full time

    Current Employees:If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet.The Central Business Office has an exciting opportunity for a...

  • Revenue Cycle Specialist

    1 week ago

    Miami, United States Alivi Full time

    Job DescriptionJob DescriptionSummary: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 that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to...

  • Revenue Cycle Specialist

    5 days ago

    Miami, United States Alivi Full time

    Job DescriptionJob DescriptionSummary: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 that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to...

  • Revenue Cycle Specialist

    2 weeks ago

    Miami, United States Alivi Full time

    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 that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to conclusively settle all claims within...

  • Revenue Cycle Specialist

    1 week ago

    Miami, United States Alivi Full time

    SUMMARYThe primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to conclusively settle all claims within the...

  • Director of Revenue Cycle

    14 hours ago

    Miami Gardens, United States HealthLinc Full time

    As Director of Revenue Cycle, you direct and oversee the overall policies, procedures, objectives, and initiatives of HealthLinc's revenue cycle activities to optimize the patient financial interaction along the care continuum. This position will review, design, and implement processes surrounding pricing, billing third party payer relationships, compliance,...

  • Revenue Cycle Payer Relations Analyst

    4 days ago

    Miami, United States University of Miami Full time

    Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet. The Central Business Office has an exciting opportunity for a...

  • Cerner Revenue Cycle Systems Analyst

    3 weeks ago

    Miami, United States Miami Children's Full time

    Job Summary Supports the business solutions within the Revenue Cycle solutions portfolio including Scheduling, Registration, Charge Services/Revenue Integrity, Health Information Management, Patient Accounting, and Finance/General Ledger. Serves as the business solution leader by providing expertise within the Revenue Cycle solutions suite and their related...

  • Cerner Revenue Cycle Systems Analyst

    4 weeks ago

    Miami, United States Nicklaus Children's Health System Full time

    Job Summary Supports the business solutions within the Revenue Cycle solutions portfolio including Scheduling, Registration, Charge Services/Revenue Integrity, Health Information Management, Patient Accounting, and Finance/General Ledger. Serves as the business solution leader by providing expertise within the Revenue Cycle solutions...

  • Cerner Revenue Cycle Systems Analyst

    4 weeks ago

    Miami, Florida, United States Nicklaus Children's Health System Full time

    Job Summary Supports the business solutions within the Revenue Cycle solutions portfolio including Scheduling, Registration, Charge Services/Revenue Integrity, Health Information Management, Patient Accounting, and Finance/General Ledger. Serves as the business solution leader by providing expertise within the Revenue Cycle solutions suite and their...

  • Revenue Cycle Business Analyst, Full-Time, Days

    4 days ago

    Miami, United States Public Health Trust of Dade Co Full time

    Department: Jackson Memorial Hospital - Revenue Cycle ManagementAddress: 1611 NW 12th Ave., Miami, Florida 33136Shift: Full-Time, DaysWhy Jackson:Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history,...

  • Revenue Integrity Data Specialist, Remote, Revenue Integrity Management, FT,08A-4:30P

    3 days ago

    Miami, United States Baptist Health South Florida Full time

    The Revenue Integrity Data Specialist will report to the Manager of Revenue Integrity Management. The Revenue Integrity Data Specialist will work along with the pre-bill edit team to take appropriate action to resolve patient account issues preventing claims and communicate to the revenue cycle departments when changes need to be made. Estimated pay range...

  • Revenue Integrity Data Specialist, Remote, Revenue Integrity Management, FT,08A-4:30P

    5 days ago

    Miami, Florida, United States Baptist Health South Florida Full time

    Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 24,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in...

  • Legal Billing Specialist

    2 weeks ago

    Miami, United States The LaSalle Group Full time

    Our client, a premier law firm, is looking for a hands-on Legal Billing Specialist to work directly alongside the billing supervisors and managers and contribute to their team. This is a great opportunity for a Legal Billing Specialist to gain experience with a global industry leader. Strong organization and communication skills are required for the role as...

  • Complex Revenue Analyst

    1 day ago

    Miami Beach, United States The Gates South Beach Full time

    Compensation Type: Yearly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Complex Revenue Manager

    2 days ago

    Miami Beach, United States The Gates South Beach Full time

    Compensation Type: Yearly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Complex Revenue Manager

    2 days ago

    Miami Beach, United States The Gates South Beach Full time

    Compensation Type: Yearly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Medical Billing and Collections

    4 weeks ago

    Miami, United States Revenue Cycle Management Profession Full time

    Job DescriptionJob DescriptionFast paced Medical Billing company looking for experienced Medical Billing and Insurance Collector ( >2 years). Must have knowledge of medical appeal guidelines, including Medicare. Need to be proficient with ICD-10 and coding guidelines. Good benefits such as; paid vacation, paid holidays, 401K, health benefits .Job Type:...

  • Medical Records Specialist

    4 days ago

    Miami, Florida, United States HCA Healthcare Full time

    Description IntroductionDo you have the career opportunities as a Medical Records Specialist you want with your current employer? We have an exciting opportunity for you to join HCA Florida Kendall Hospital which is part of the nations leading provider of healthcare services, HCA Healthcare.BenefitsHCA Florida Kendall Hospital, offers a total rewards...