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Revenue Cycle Systems Support Specialist
3 months ago
Lutheran Social Services of WI and Upper MI is currently seeking a Revenue Cycle Systems Support Specialist. This is a full-time, benefit eligible opportunity. The Revenue Cycle Systems Support Specialist with a focus on Central Intake, analyzes, and coordinates all aspects of the client intake process for designated LSS entities. This position plays an important role in the revenue cycle and provides integral support to financial operations by ensuring accurate insurance coverage, benefit assignments, timely prior authorizations, and quality assurance.
Essential Duties and responsibilities:
This list of duties and responsibilities is as follows
* Communicates both within and outside of the department to resolve problems and expedite work.
* Deliver excellent customer service while maintaining an understanding and supportive demeanor.
* Excellent communication and customer service skills to be able to explain processes.
* Communicate effectively with program staff to correct errors.
* Excellent problem-solving skills to be able to process changes and work with others to resolve issues.
* Create and edit documents (Word, Excel, PowerPoint, etc.), some of a complex nature.
* Understands the various programs and services provided within LSS and actively looks for opportunities to streamline data collection and eliminate duplication of efforts.
* Produces reports as needed.
* Develops documentation, training materials, and self-help systems.
* Has ability to maintain a high level of confidentiality.
* Utilizes consistent tools and templates to capture and clarify project requirements, processes, designs, solutions, training materials, and support procedures.
* Identifies solutions, technology needs, and process changes necessary to implement a successful project.
* Prioritize and schedule own work assignments to ensure maximum productivity is achieved.
* Follows all LSS rules and regulations pertaining to HIPAA laws.
* Participate in other projects and other duties, as assigned, and needed.
Intake
* Data entry into an electronic health record software system.
* Enter a client referral into the electronic health record software system.
* Request and ensure receipt of referral from program and external funders.
* Act as a liaison between the county, program, and financial services.
* Handle workflow from multiple programs across the agency.
* Organize and maintain files electronically.
* Verify eligibility with funding sources.
* Performs insurance prescreening and verification of insurance benefits.
* Ensure client coverages meet company and/or insurance guidelines.
* Verify client's network status with insurance payers.
* Maintain an accurate information stream that meets the needs of clients & programs.
* Check figures, postings, and documents for correct entry, mathematical accuracy, and proper codes.
* Comply with federal, state, and company policies, procedures, and regulations.
* Collect appropriate consent forms.
* Advise program leaders of discrepancies when funding source guidelines when new referrals or program changes are received.
* Manage a centralized intake ticketing system to track referrals for multiple programs and users.
* Create a customized process and procedure intake guide for all programs inclusive of payer eligibility criteria, policy, coding, and billing rules.
Insurance & Reimbursement
* Collect client insurance information.
* Verify client insurance eligibility of benefits.
* Stay up to date on complex insurance regulations.
* Review monthly reports that document overall profits and losses.
* Provide prior authorization assistance, including billing & coding instructions.
* Navigate insurance portals to verify insurance and benefits .
* Researches, analyzes, and collaborate with financial services team to resolve billing issues.
* Responsible for a variety of functions related to insurance coverage including verification of insurance benefits and CPT/ICD coding.
* Utilize available funder information regarding allowable services, codes, etc. Examples: Medicaid handbooks, service handbooks, state, or county level direction.
* Ensure EHR, billing reports, authorizations, coding, and documents are in place to achieve maximum reimbursement.
Authorizations
* Process authorizations. (Specific to a program and insurance guidelines)
* Communicate with agency billing department and external funders regarding authorizations.
* Track and maintain authorizations based on current provider credential status.
* Monitor and track authorizations.
* Initiates communication to the programs when authorization is not obtained or expired.
* Verify codes, units, and services on authorizations align with funder guidelines
* Follow a system of review that addresses the requirements of the funder.
* Utilize available funder information regarding allowable services, codes, etc. Examples: Medicaid handbooks, service handbooks, state, or county level direction.
* Create resource guides, tools, and education materials for programs to obtain accurate authorizations.
* Utilize third party administrator systems, online systems, and reports.
* Submit prior authorization requests to health insurance companies.
* Run and review custom reports.
* Request programs to amend authorizations to update units, rates, dates or codes.
Quality Assurance
* Follow a system of review that addresses the requirements of the funder.
* Ensure consistency and accuracy of service notes and invoices by funder.
* Understand the workflow associated with service delivery and the documentation process.
* Understand the interface between the documentation requirements and the electronic health record.
* Effectively communicate to program staff regarding the documentation requirements and correcting errors.
* Collaborate and communicate with financial services team members to coordinate the submission of invoices and service notes in alignment with funder requirements.
* Communicate changes to the appropriate agency staff regarding documentation expectations of the county.
* Create the billing foundation.
* Compare authorization to current payer guidelines to ensure accurate coding.
* Create resource guides, tools, and education materials for programs for common problem areas.
ADDITIONAL AGENCY REQUIREMENTS (Required of all employees):
* Must comply with agency and departmental policies and regulations.
* Must relate to individuals and families of varied ethnic and cultural backgrounds, ages, and economic circumstances with respect and dignity.
* Must support the Mission, Vision, and Values of the Agency.
PERKS:
* Training Onsite in West Allis, WI, then able to work remotely 3-4 days a week
* Public Service Loan Forgiveness (PSLF)
*
By being employed with LSS, which is a non-profit agency, you can be eligible for loan forgiveness under the Public Service Loan Forgiveness program.
* Loans are eligible to be forgiven after 10 years of on-time and consistent payments through the income-based re-payment plan.
* Medical/Dental/Vision Insurance
* Flex Spending for Dependent & Health Care
* Mileage reimbursement
* Paid Time Off
* 10 Paid Holidays
* Ability to Contribute to 403B
* LSS makes annual raises a priority for employees
* Employee Assistance Program
* Service Awards and Recognition
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Upon offer, candidates must successfully complete the necessary background, caregiver, medical and any other checks required, according to program requirements. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION AND/OR EXPERIENCE:
* High school diploma or GED required. Associate degree (AA) or equivalent from a two-year college or technical school is preferred.
* Minimum 5+ years prior medical or behavioral health insurance experience is required.
* CPT/HCPCs and ICD10 knowledge.
* A basic understanding of the credentialing and provider network status.
* Proficiency in a variety of software programs (Microsoft Word, Excel, PowerPoint, Outlook, or equivalent) is required.
* Knowledge of Medicare, Medicaid, and third-party payer requirements.
* Experience with prior authorizations.
* Attention to detail and strong organizational skills.
* Technical ability.
* Ability to balance multiple competing priorities and deadlines.
* Ability to identify and implement new processes.
* Ability to work in a fast-paced environment, both independently and as part of a team.
* Demonstrated verbal and written communication skills.
* Mathematical aptitude, effective communication, and critical thinking skills.
* Demonstrate ability to identify and understand issues and problems.
* Examines data and draws logical conclusions based on information available.
LANGUAGE SKILLS: Ability to communicate both in verbal and written format, effectively and efficiently in job is required. Ability to write routine reports and standard documentation. Ability to speak effectively to vendors and other employees of the organization.
COMPUTER SKILLS/TECHNOLOGY:
Working knowledge of computers to allow employee to access computer systems and applications to complete timecards, read and respond to email, and complete required on-line training. To perform this job successfully, an individual should have knowledge of Microsoft Office (Word, Excel, Outlook, and PowerPoint) and the ability to quickly learn new software programs.
* Working knowledge of computers to allow employee to access computer systems and applications to complete timecards, read and respond to email, and complete required on-line training.
* Ability to utilize efficiently an electronic health record(s) for documentation of direct services.
* Must be able to work on computer and utilize computer applications and programs to effectively complete the job.
* Ability to work within a variety of ever-changing software packages and computer systems.
* Create and edit complex documents, spreadsheets, presentations, etc.
* Maintain records and accurate filing systems.
* Regular use of technology for meetings and communication to include email, conference calls, web-based meetings, and webinars.
PHYSICAL DEMANDS/WORK ENVIRONMENT:
The physical demands and work environment 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 sit and use hands to finger, handle, or touch objects, tools, or controls. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; and stoop, kneel, or crouch. The employee must occasionally lift and/or move up to 25 pounds, carrying and moving payroll records and printer paper. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Work may be performed remotely, however, at management discretion, the incumbent of this position may be required to work in an air-conditioned, office environment.
The incumbent will also be exposed to outdoor weather conditions when traveling on company business.
TRAVEL: Ability to travel on day trips as required but would not be often. Some overnight travel may be required.
LSS is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other characteristic protected by federal, state or local law.
