Senior Revenue Cycle Specialist

1 day ago

Dallas, Texas, United States Stride Healthcare Management LLC Full time
Job Title: Senior Revenue Cycle Specialist

Stride Healthcare Management LLC is seeking a highly skilled Senior Revenue Cycle Specialist to join our team. The ideal candidate will have prior experience in Medical workflows, Revenue Cycle functions, and be knowledgeable of reimbursement/compliance process and procedures with all payors.

Key Responsibilities:

  • Performs manual and electronic posting functions for all payors/patient accounts, including cash balancing and reconciliation of bank deposits.
  • Post payment corrections, payment transfers, and NSF's.
  • Researches and clears unapplied accounts using established identification functions/process.
  • Analyzes and corrects insurance account receivable and payment posting ledger and posting errors.
  • Reviews patient accounts to determine and correct any discrepancies; account audits, aging AR, unapplied adjustments, resolving credit balance, unposted payments.
  • Ledger accuracy and account integrity.
  • Thoroughly researches all payor recoupments and identifies errors and/or opportunities to dispute and restore loss in revenue. Researches and validates patient refunds prior to processing refund to patient and/or state for unclaimed funds.
  • Maintains knowledge of insurance rejections/denial processing and appropriately posts information for collection and follow-up activity.
  • Researches and follows up on all correspondence associated with assigned accounts, including EOB's and documentation letters, and generates correspondence requesting required information when necessary.
  • Responsible for all aspects of follow-up and collections, including making phone calls, accessing payer websites. Identifies issues or trending and provides suggestions for resolution.
  • Accurately and thoroughly documents the pertinent collection activity performed. Reviews the account information and necessary system applications to determine the next appropriate work activity.
  • Reviews, investigates, and resolves claims that have been rejected or denied by insurance.
  • Initiates appeals and ensures all required documentation is submitted in the appeal process. Researches all denials and follows up as necessary.
  • Verifies claims adjudication utilizing the appropriate resources and applications.
  • Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds.
  • Answers patient billing questions and acts as a resource for patient billing questions.
  • Initiates telephone or letter contact to patients to obtain additional information as needed.
  • Verifies insurance benefits utilizing website, fax, and phone. Knowledge of plan types/builds and how to create within the system.
  • Performs appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edits claims to meet and satisfy billing compliance guidelines for electronic claim submission.
  • Processes dental clean claims for payment by all insurance companies to ensure appropriate and timely coding, billing, and collections.
  • Manages and maintains assigned workload, completes reports, and resolves high-priority and aged inventory.
  • Responsible for meeting goals and objectives in assigned areas of revenue cycle operations.
  • Identifies problems or improvements within own areas, develops resourceful and alternative solutions for work improvement or problem solution.
  • Other duties and responsibilities as assigned by leadership.

Requirements:

  • Prior experience in Medical workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow-up, and payment posting process.
  • Must be knowledgeable of reimbursement/compliance process and procedures with all payors.
  • Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office—strong Excel skills). Strong computer literacy, excellent math and problem-solving skills. Data entry and 10-key by touch.
  • Strong interpersonal and organizational skills. Ability to work within a team setting and as an individual contributor. Excellent oral and written communication skills.
  • Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue Cycle standard operating procedures.
  • Organized work habits, accuracy, and proven attention to detail with strong analytical skills.
  • Nice to have ICD-10 coding certification or experience in a health system.

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