Revenue Cycle Specialist- Denials

3 weeks ago

Stamford, United States The Stamford Hospital Full time

The Revenue Cyle Specialist is responsible for researching, resolving, and resubmitting denied claims; taking timely and routine action to collect unpaid claims; and interpreting various forms of explanations of benefits (EOBs) from insurance carriers

* Understands and interprets insurance Explanations of Benefits (EOBs), knowing when and how to ensure that maximum payment has been received.
* Researches and resolves rejected, incorrectly paid, and denied claims within an established time frame.
* Researches and resolves unpaid accounts receivable and makes any corrections in medical group's practice management system necessary to ensure maximum reimbursement for all services rendered.
* Resubmits claim forms as appropriate.
* Professionally responds to all billing-related inquiries from patients, staff, and payers in a timely manner.
* Utilizes available resources to identify reasons for payment discrepancies.
* Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
* Accurately documents patient accounts of all actions taken.
* Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements.
* Educates clinic management and staff regarding changes to insurance and regulatory requirements.
* Actively participates in practice management and payer meetings.
* Accurately documents patient accounts of all actions taken.
* Establishes and maintains a professional relationship with all SHMG staff in order to resolve problems and increase knowledge of account management.
* Maintains standards set by management.
* Apprises management of concerns as appropriate.
* Informs management, as appropriate, regarding backlogs and time available for additional tasks.
* As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.
* Completes additional projects and duties as assigned.
* Associate's degree or medical billing certification preferred. CPC preferred.
* 3+ years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.
* 3+ years of experience working with a medical office/hospital accounts receivable system.
* Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.
* Demonstrates overall knowledge of claims processing for various insurances, including private and governed.
* Comprehensive knowledge of ICD-10, CPT, and HCPCS coding.
* Moderate to advanced computer skills, including Microsoft Windows programs.
* Moderate to advanced keyboard skills with high accuracy rate.
* Ability to communicate effectively in written and spoken English.
* Demonstrates effective communication and interpersonal skills with a diverse population.
* Ability to organize and prioritize workload to manage multiple tasks and meet deadlines.
* The ability to work with individuals at all organizational levels, particularly peers, team members, other departments, patients, and the community is required.
* Demonstrates the ability to carry out assignments independently, work from procedures, and exercise good judgment.
* Demonstrates the ability to maintain the confidentiality of all records.

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