Revenue Cycle Representative

Why Join Us?

For us, what matters most is excellence. We are caring professionals, people who live, work and dedicate themselves to the communities of Central New Jersey. As such, we strive to provide a sanctuary of excellence, precision, thoroughness and genuine compassion. We also take a whole-person approach to patient care and treatment, tailoring all that we do around their unique needs. And we do all we can for patients, going the extra mile to see that they're supported, informed and getting the one-on-one care and service they deserve.

Job Description:

The Revenue Cycle Representative (RCR) for the practice is a customer service and financial related position with primary focus to communicate between the physicians, insurance company representatives, contracted billing vendor and the patient. The RCR will provide exceptional customer service to our external as well as internal customers. Support service excellence standards to all our customer groups, utilize tools and processes to make independent decisions and will maintain integrity and treat internal and external customers respectfully.

1. Contact patients, insurance companies, pre-authorization, referrals to resolve patient account inquiries as representative of the physician practices that require RCR.

2. Maintain strict confidentiality of patient and center related business.

3. Ensure all patient appointments are financially secured by completing insurance notification if referral or preauthorization is required.

4. Analyze and verify patient demographic, insurance eligibility and financial information/responsibility for accurate claim submission and reimbursement.

5. Identify & report trends and reimbursement modeling errors and/or underlying causes of incorrect payment; review allowed variances from third party payers.

6. Be expected to maintain a high-level of accuracy to meet productivity and quality requirements.

7. Identify trends and/or work processes for potential process improvements.

8. Review and analyze report data to provide status updates to leadership.

9. Communicate with providers, payers, patients, internal departments, co-workers and supervisor to resolve issues.

10. Assists with Coding form submission accuracy to assure timely RCM workflows.

11. Maintain extensive working knowledge and expertise based around payer regulations/policies, financial classifications.

12. Build and maintain solid working relationships with clinical staff, referral sources, insurance companies, medical providers and public.

13.Work queries related to referrals/pre-authorizations, and any associated denials and requested documentation.

14. Provides customer service to patients by educating them on insurance policies, billing procedures and coding issues.

15. Acts as a resource to physicians and staff regarding authorization requirements to assure returns meet best practice

16. May provide training to others on billing procedures and practices. All other duties as assigned.

QUALIFICATIONS: Experience maintaining professionalism while handling difficult situations with callers or customers. Demonstrated ability to maintain or improve established productivity and quality requirements. Familiarity with medical terminology. Basic knowledge of Health Insurance Portability and Accountability Act (HIPAA) laws. Basic knowledge of healthcare billing (healthcare revenue cycle); insurance, and/or federal and state billing regulations.