Revenue Cycle Specialist

4 weeks ago

Grand Rapids, United States Alliance Physical Therapy Partners Full time

Summary: The Revenue Cycle Specialist works as part of a team to obtain appropriate adjudication and payment of claims from insurance companies on outstanding receivables. They will work specific accounts assigned to them and follow-up on no-response and denied claims per established workflows and processes. They will analyze their assigned A/R and communicate any payer trends along with recommended solutions when applicable to RCM leadership. The position is responsible for following all compliance, Medicare, and HIPAA policies.

Essential Duties and Responsibilities:

Accounts Receivable - Insurance

* Responsible for a section of the A/R making sure claims are being effectively worked and accounts are not aging from bucket to bucket.
* Address denials and determine next steps following established protocols and work flows.
* Follow up on unpaid claims
* Answer billing inquiries from other departments, patients and/or clinic staff.
* Enter electronic notes on patient accounts giving a full description of phone calls, denials, re-bills, etc.
* Utilize clearinghouse tools effectively
* Re-bill or submit corrected claims when applicable
* Status unpaid claims and patient accounts
* Monitor provider newsletter and communications for changes impacting claims payment.
* Prepare insurance refunds.
* Request Off-sets or Take-backs for overpayment.
* Address Help Desk tickets related to claims issues.

This list of duties is not intended to be all-inclusive and may be expanded to include other duties or responsibilities that senior management may deem necessary.

Qualifications/Skills

* Minimum of one (2) years of experience in medical billing and account follow up.
* Demonstrated communication skills, both written and verbal, to effectively interface and maintain effective relationships with all levels internally and externally.
* Must be able to develop and maintain professional, service-oriented working relationships with insurance companies, patients, physicians, co-workers, and supervisors.
* Strong insurance/patient accounting systems knowledge and skills.
* Strong computer skills with experience in collection and various other data systems.
* The ability to use Microsoft Office and other software programs as necessary to prepare appropriate analysis and reports. Notably, the ability to maintain spreadsheets in Microsoft Excel.
* Familiarity with CPT and ICD-10 coding required (certification not required). Medical coding, a plus.
* Ability to work in an ambiguous, fast-moving environment while successfully attaining timely deliverables.
* Strategic and self-directed with sound judgment, technical and analytical abilities.
* Use of sensitive information in a confidential and discretionary manner.
* Ability to work well with others - strong teamwork skills.

Performance Measurements:

* Customer service
* Communication
* Accuracy
* Timeliness
* Organization
* Discretion and good judgement
* Follow-through of responsibilities
* Technical skills
* Collaboration/teamwork

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to sit at a desk for prolonged periods of time while working on a computer. They are also required to frequently reach with their hands and arms. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

Full-Time Position

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