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Home Health Revenue Cycle Specialist

1 month ago

Ada, United States The Chickasaw Nation Full time

We are currently looking for a Full Time Home Health Revenue Cycle Specialist to join our Health Revenue Billing and Accounts Receivable Team team located at the Chickasaw Nation Medical Center working 8:00AM-5:00PM - Mo Tu We Th Fr.

Summary:

The Home Health Revenue Cycle Specialist will be responsible for prior authorization, accounts receivable, and claim generation functions necessary to ensure maximum support of third-party revenue cycle.

Responsibilities:
* Verifies patient insurance, confirms benefits eligibility, performs authorizations, pre-certification, and/or notification for Home Health
* Documents insurance requirements in patients' electronic health records
* Resolves claims issues with Medicare, Medicaid, Commercial, and Managed Care
* Researches missing information needed to submit a clean claim
* Traces all claims to payers to ensure that claims are being paid in a timely manner
* Follows-up with insurance carriers on denied/rejected claims to work with carrier for resolution on claim
* Maintains accurate notes in billing system for follow up activity
* Accurately interprets Explanation of Benefits (EOBs) to identify payment discrepancies
* Monitors all reports to ensure that claims are accepted and ensures accurate re-submission of rejected claims
* Reviews suspended or denied claims and makes corrections for resubmission for reimbursement
* Analyzes and maintains a portion of the total billing operation for third party programs and acts as an advocate for the Health System in collection of alternate resources
* Promotes positive teamwork and cooperation within all areas; Billing, Collecting, Posting, Pre-Registration, and Prior-Authorization as they will work closely with each other and are dependent upon each other's success
* Maintains confidentiality, security, and integrity of data and information
* Provides first class customer service - courteous and helpful to all internal and external customer types
- Answers questions in a courteous and professional manner
- Partners with internal and external services as needed to ensure appropriate referral is made
- Greets and engages with a smile
- Determines needs, seeks positive experience and outcomes
* Completes all training and development requirements and participates in continuing education opportunities
* Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
- Maintains general upkeep of work area and maintains a safe environment
- Maintains and promotes professionalism
- Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
- Adheres to Chickasaw Nation dress code standards
* Maintains knowledge of and follows all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
* Performs all other duties as assigned

Competencies:
Essential:
* Able to follow instructions, both written and oral
* Able to adhere to all scheduling and attendance requirements
* Must be able to exert analytical and critical thinking skill
* Must be detail-oriented
* Must be self-motivated
* Ability to work independently
* Honesty, truthfulness, reliability, accountability
* Able to read, understand and apply regulations and policies
* Possess basic knowledge of medical terminology
* Knowledge of insurance authorization and billing processes
* Ability to proofread for spelling, grammar, and formatting errors and make appropriate modifications
* Applied knowledge of medical coding and billing guidelines
* Knowledge of relevant privacy regulations such as The Privacy Act, Freedom of Information Act and Health Insurance Portability and Accountability Act (HIPAA)
* Knowledge of third party payor guidelines
* Knowledge of revenue cycle billing, hospital billing, professional billing, and claims processing operations and workflows
* Must be proficient in the use of electronic health record keeping systems
* Working knowledge of managed care and other health plan eligibility, benefit determination, precertification and referral requirements and processes
* Organizes work and assigned area logically and orderly
* Establishes professional working relationships as appropriate
* Able to verbally communicate in a professional and positive manner with other team members, departments, guests and management
* Writes effective communications with team, departments, guests and management

Skills:
Essential:
* Intermediate computer skills
* Intermediate skill using Microsoft Office products
* Excellent Phone Skills
* Accurate typing and/or data entry skills

Experience:
Essential:
* 1 year directly related experience

Education:
Essential:
* High School, GED or Equivalent

Nonessential:
* Bachelors Degree in directly related field

Credentials:
Essential:
* Pass general background check
* Standard Driver's License

Working Conditions:
Essential:
* Works in an office setting
* Sitting up to 100% of shift
* Sometimes lift and or carry up to 10 lbs
* Standing up to 25% of shift
* Walking up to 25% of shift
* Sometimes bend, kneel, stoop, push, reach
* Subject to traveling and working at other locations or in other environments
* Pass pre-employment drug test