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Revenue Cycle Compliance Specialist
2 months ago
The Revenue Cycle Compliance Specialist plays a crucial role in analyzing explanations of benefits, denials, and outstanding accounts receivable. Operating with minimal oversight and following established protocols, this position collaborates daily with colleagues and various departments to swiftly address unresolved account balances while enhancing the customer experience and ensuring a high standard of integrity and compliance for Gila Regional Medical Center.
Key Responsibilities:
- Possesses comprehensive knowledge of third-party eligibility and claim inquiry tools, regulatory requirements, and guidelines.
- Conducts audits on inquiries to verify the appropriateness of patient responsibility, ensuring accurate registration, coding, payment/adjustment posting, and claims processing.
- Adheres to all daily, monthly, and year-end closing deadlines related to the accounts receivable process.
- Provides mentorship and training to team members in account research.
- Notifies management of any discrepancies affecting the integrity of accounts receivable.
- Reviews all explanations of benefits to validate patient responsibility and ensure proper registration, coding, payment/adjustment posting, and claims processing.
- Handles remittance, payment, and related documentation, including scanning and submission of information.
- Informs management of recurring issues and suggests improvements to enhance departmental quality outcomes.
- Prioritizes tasks and organizes workload to meet deadlines effectively.
- Contributes as a team member by undertaking additional assignments as needed and directed by management.
- Maintains strict confidentiality and complies with all HIPAA regulations.
- Demonstrates meticulous attention to detail, initiative, and sound judgment.
- Exhibits professionalism, tact, and empathy when interacting with patients and clients.
- Performs other duties and special projects as assigned.
- High school diploma or equivalent GED.
- Preferred qualifications include education as a Registered Nurse or coding professional related to clinic and hospital reimbursement.
- Understanding of billing processes and the ability to support chargemaster maintenance to ensure compliance with CMS.
- Prior experience in revenue cycle management is preferred, particularly for individuals with a clinical or coding background, enabling them to lead self-driven projects and enhance caregiver engagement in refining or developing processes related to compliance and charge capture.
- Knowledge of insurance requirements, regulations, contract benefits, credit and collection procedures, and financial assistance programs, along with familiarity with medical terminology, is essential. This level of expertise is typically gained through two to four years of experience in medical billing.
- Interpersonal skills are necessary for effective patient interactions, with the ability to manage interruptions from colleagues or other internal customers requiring assistance with patient accounts.
- Analytical and critical thinking skills are required to diagnose account issues, along with active listening abilities to ensure service excellence. Project and time management skills are also essential for effective teamwork.
- Familiarity with insurance types, including Medicare, Medicaid, HMO, PPO, and commercial insurance verification, as well as COB guidelines and knowledge of ICD-10 coding, is necessary.
**All required documents must be presented at the time of hire.**
Gila Regional Medical Center is an Equal Opportunity Employer.
