Revenue Cycle Specialist

4 weeks ago

Delta, United States Delta Health Full time
Description

Delta Health offers health care professionals and people from all walks of life an opportunity to find fulfillment in their jobs as part of a close-knit team.We pride ourselves on ourpositive work culture . Our team members understand our fundamental commitment to the community and rally around the motto "Excellence, Every Patient, Every Time."When you embark on a journey with us, you'll take pride in your work and the impact you have, while building a career with focus and purpose.

The Revenue Cycle Specialist will provide support for all aspects of insurance billing, as well as claims follow up and collections.This position will have direct contract with the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeal, non-payment, overpayments, and underpayments.Takes action to bring outstanding accounts receivable (A/R) to a zero balance, preferably by the collection of payment in full. Reviews open A/R accounts and takes appropriate action on those accounts.Those actions are defined in general by hospital policy, and sometimes in specific policies or procedures. Specific actions can include, but are not limited to asking patients for payment in full, setting up payment arrangements, working with third party payers to pay the claim, issuing contractual allowances, sending or recommending accounts to collections or for charity Organizes the collection and reporting of information for the Colorado Medically Indigent Program.Reports needed information to Utilization Review.Reviews and routes bills appropriately as they are produced from the information system. Works closely with facility coding, physician billing and admissions.

Position Responsibilities:

  • Ensures efficient processing of billing claims, insurance follow up, collection activities, and denials.Assists in meeting cash collection goals by reviewing, completing, and submitting appropriate documentation based on payer requirements.
  • Performs billing, follow-up and collection functions for third-parties, resolving issues that impact or delay claims payment.Update data regarding changes and modifications in plan benefits and other contract information relevant to the billing or claims follow up and collection process.
  • Serves as support staff for various departments and external payers by developing positive relationships with managed care organizations, outside agencies, and clinical areas within the organization.Review and responds to correspondence and inquiries generated by third party payers.Provide medical record copies and other pertinent information to the appropriate sources.
  • Works collaboratively to facilitate the insurance billing and collections process to improve overall cash collection
  • Professionally answer incoming telephone calls from Payers and patients providing answers to questions and concerns about billing statements.Return all unanswered calls within 24 hours of receipt and handle all correspondence within a week of receipt.
  • Work exception and rejection work queues and review EOB's for correct contract payment.
  • Monitors the status of denials, appeals, and claim errors by using folders/work queues and conducting routine, periodic follow up on previously researched claims items.Monitors, review, and suggest revisions or updates to existing forms, documents, and processes required to facilitate timely billing and collections.
  • Prepares and sends written appeals when necessary with appropriate documentations??
  • Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment.Maintain awareness of current regulations.
  • Supports overall Revenue Cycle processes to achieve established target and goals, including the completion of special/specific assigned projects and other duties or tasks assigned.
  • Researches refund requests and submits to Revenue Cycle Director for approval from CFO.
  • Reviews Late charge report for claim correction if late charges have been added or removed from the accounts
  • Reviews ER report for VA patients to make sure that phone call has been made to 72 hrs. line in order to get authorization for emergencies services for veterans (if this hasn't been done by admissions I go and do it in VA portal)
  • Utilizing Change / Clearinghouse - work unreleased claims and claim corrections (primary, secondary, etc.)
  • Collect Payments from patients and enter and maintain cash drawer to be balanced daily during shift
  • Scan all necessary documentation to the accounts
  • Posting adjustment transactions from remit denials after following up.
  • Responsible to manually hand key C/O claims into Health First Colorado Medicaid Portal. Work change sending clean claims, send corrected claims 137, send recoupment claims 138.
  • Download W/C claims in CHANGE, call for W/C Claim information, call for AUTO claim information.
  • Provide and create UB04 for patients when necessary for accident.
Requirements
  • High School Diploma or equivalent; post-secondary education a plus.
  • Minimum of 2 years of healthcare related experience in billing and collections or medical billing certificate.
  • Insurance eligibility and benefit verification experience required
  • Knowledge with CMS 1500 and UB04 Billing Forms, EOBs, claims, coding and charges is required.
  • Knowledge of third-party and insurance companies' operating procedures, regulations and billing requirements; i.e. Commercial, Medicare, Medicaid, etc.
  • Ability to read and understand the information provided on EOB's, remittance advices, and other insurance correspondence.
  • Knowledge of medical terminology and ICD-10 beneficial.
  • Excellent verbal and written communication skills
  • Effective customer service skills with the ability to interact with both internal and external customers.
  • Ability to prioritize work, handling daily and multiple tasks to completion within the time allotted, while working as part of a team within a demanding environment.
  • Proficiency with Microsoft Office tools with a sharp technical aptitude.
  • Ability to work independently with minimal supervision.


Summary

Delta Health is a county-wide healthcare system that has been serving the Western Slope for over 100 years. We have grown to a 49-bed hospital with locations throughout Delta County. We proudly provide a wide range of medical services that meet the diverse needs of our community members. At all stages of life, we are here to provide remarkable care in a healing environment.

Employee Benefits: Medical, RX, Dental, Vision, Retirement, PTO, and Scholarships towards continued education.

Medical: Low monthly premiums; 100% coverage for all services provided within our Delta Health System without a deductible or co-payment. We offer alternative coverage to include massage, acupuncture, and chiropractic care. Employer paid Life and Disability coverage.

Paid Time Off: 4 plus weeks of vacation (CAL) a year for Full-Time employees including sick pay and personal time off.

Retirement: 403B Plan -Up to a 3% retirement match.

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