Revenue Cycle Specialist

1 week ago


Atlanta, Georgia, United States SENTA Partners Full time
Position Overview
The Revenue Cycle Representative plays a crucial role in managing and resolving claims denials. This position involves thorough research and analysis to determine the validity of denial cases and to strategize effective appeals.

Key Responsibilities
  • Conduct comprehensive investigations into claims denials to ascertain whether there is a valid basis for challenging the denial.
  • Ensure that all relevant documentation supporting the appeal is meticulously organized and complete, with a well-structured appeal letter that presents a logical argument. Utilize the most compelling evidence available to substantiate the appeal and identify any missing documentation necessary for a robust appeals package.
  • Review and verify all appeal exhibits and evidence for accuracy, ensuring that the appeal letter is free from spelling, grammatical, or syntax errors prior to submission.
  • Adhere to internal documentation control protocols for timely submission of appeals.
  • Engage in effective communication and collaboration with both internal and external stakeholders to address any inquiries or concerns that arise during the appeal process. Escalate significant customer issues to management as needed.
  • Follow up diligently on all corrected claims and appeals submitted.
  • Maintain detailed and clear notations in the EMR system for all accounts managed.
  • Calculate anticipated claim reimbursements accurately.
  • Possess a solid understanding of payor policy guidelines and contractual agreements.
  • Have a comprehensive understanding of fee schedules.
Qualifications
  • High School Diploma required.
  • Preferred 2 years of relevant experience.
  • Exceptional verbal and written communication skills.
  • Strong organizational skills with a keen attention to detail.
  • Maintain a professional and friendly demeanor.
  • Thorough knowledge of payor policies and guidelines.
  • Familiarity with coding standards.


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