Revenue Cycle Specialist
4 weeks ago
Alivi exist to help people live a happier and healthier life. We design, build, and manage healthcare benefits. Alivi has over 200 employees that manage supplemental and value-based healthcare benefits. The benefit solutions include non-emergency medical transportation, card-based benefits (i.e., Flex, OTC, Wellness), and specialist benefits (i.e., physical therapy, podiatry). Alivi was founded in 2016 and has been ranked by the Inc. 5000 list as one of the nation’s fast growing private companies. This recognition amongst many, is just one of the few testaments to the unwavering dedication to provide healthcare solutions that help increase the quality of care, enhance the member experience, and lower healthcare costs.
JOB SUMMARY:
The Revenue Cycle Specialist is responsible for the accounts receivable including the collection, coordination of billing processes and communicating trends and patterns to the claims and finance team. Properly apply contractual obligations and adjustments when performing billing functions. A key function of this role is coordinating tasks to ensure all deadlines, both external and internal, are met.
DUTIES & RESPONSIBILITIES:
• Correctly and efficiently reviews demographic and patient insurance data in our proprietary billing system as it relates to covered services and areas.
• Accurately assess claims and identify any problematic issues associated with adjudication that may impact upstream billing to payers.
• Effectively communicate with insurance companies to ascertain claim status and accurate claim dispositions.
• Review 277/277CA responses and complete rejection process.
• Review 835s and rebill claims, as necessary.
• Review denials to determine appropriate action based on carrier requirements.
• Provide follow up with payers or internal claims processing team on denied or unpaid claims as applicable to the root cause of the denial; this could be an insurance plan error or internal processing such as in the case of coordination of benefits or billing configuration.
• Serve as the point of contact for all inquiries from insurance companies, while providing superior customer service.
• Continued professional development desired and encouraged.
• Maintain strictest confidentiality; adhere to all HIPAA (Health Insurance Portability and
Accountability) and other industry rules and regulations.
REQUIREMENTS & QUALIFICATIONS:
• A minimum of 3 years’ experience in end-to-end revenue cycle management
• High school diploma required; Associate’s/bachelor’s degree is a plus.
• Knowledge of billing procedures and collection techniques
• Professional personal presentation
• Experience working independently, as well as member of various teams and/or workgroups.
• Strong computer skills and knowledge of MS Office products, specifically Excel.
• Ability to quickly navigate between different system platforms.
• Strong written and verbal communication skills.
• Strong organizational skills, problem-solving, and analytical skills.
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