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Revenue Cycle Specialist I

3 months ago

Casa Grande, United States Sun Life Health Full time

**STATEMENT OF PURPOSE**:
The Revenue Cycle Specialist plays a crucial role in revenue generation and collection. This position involves working with healthcare providers, insurance companies, front office staff, back-office staff, and patients to ensure accurate billing and timely payment. A Revenue Cycle Specialist I is responsible for managing and optimizing the financial processes of patient care. Their primary responsibility is to review the entire revenue cycle process, which includes tasks such as billing, insurance claims processing, and payment collection.

**ESSENTIAL FUNCTIONS**:

- Manage the effective use of the Owner Lists in practice management system in the daily management of receivables:

- Work Denial Review & Mail
- Work aging accounts, focus on resolving aging buckets >61 days/high dollar accounts first
- Work all miscellaneous work. Miscellaneous includes write-off’s, appeals, refunds, medical records requests.
- ** Claims Processing**: Submit and process insurance claims accurately and in a timely manner. Monitor claim status and follow up on any denials or discrepancies.
- ** Insurance Verification**: Verify patient insurance coverage and eligibility.
- **Patient Billing**: Generate patient statements, process payments, and address patient inquiries regarding billing and payment options.
- ** Financial Counseling**: Provide financial counseling to patients, explaining their insurance coverage, estimated costs, and payment options.
- ** Account Reconciliation**: Reconcile accounts, identify, and resolve discrepancies, and ensure accurate financial records.
- ** Credentialing**: responsible for being the liaison between the contract credentialing specialist, the Provider Recruiter and Human Resources staff, verifying and maintaining the credentials of healthcare professionals with insurance payors, ensuring that they meet the requirements and standards set by regulatory bodies, healthcare organizations, and accrediting agencies. Additionally, working with organizations to obtain or maintain facility credentials.
- ** Compliance**: Stay informed about healthcare regulations, coding changes, and compliance requirements. Ensure adherence to industry standards and legal requirements.
- ** Training**: Provide training to staff on billing processes and compliance requirements.
- Make recommendations to the Revenue Cycle Manager when the need for improvements is noted in any area affecting accounts receivable.
- Monitor claims on an ongoing basis to ensure payment prior to or at 90 days aging as the goal.
- Monitor for unacknowledged claims and ensure that they are re-billed in a timely manner.
- Participate with billing office personnel in the correcting and rebilling process of all claims not adjudicated upon initial billing.
- Keep the Revenue Cycle Manager up to date on statistical information regarding the correcting and rebilling process of all claims not adjudicated upon initial billing.
- Design and manage appropriate feedback loops so that the issues discovered as causing payment delays are not perpetually repeated.
- Notify the Revenue Cycle Manager when charges, payments or adjustments are not being correctly dispersed in the practice management system.
- Participate in group projects as needed to correct billing issues in the practice management system and related software.

**EDUCATION AND EXPERIENCE**:

- High School diploma or equivalency
- Experience in a Medical Office billing environment
- Courses in medical terminology and coding
- Experience in problem solving and the use of analytical skills
- Computer literate