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Senior Revenue Cycle Specialist

2 months 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. As a key member of our revenue cycle operations team, you will be responsible for ensuring the accurate and timely processing of medical claims, managing patient accounts, and maintaining compliance with regulatory requirements.

Key Responsibilities:
  • Perform 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.
  • Research and clear unapplied accounts using established identification functions/process.
  • Analyze and correct insurance account receivable and payment posting ledger and posting errors.
  • Review patient accounts to determine and correct any discrepancies; account audits, aging AR, unapplied adjustments, resolving credit balance, unposted payments.
  • Maintain ledger accuracy and account integrity.
  • Thoroughly research all payor recoupments and identify errors and/or opportunity to dispute and restore loss in revenue. Research and validate patient refunds prior to processing refund to patient and/or state for unclaimed funds.
  • Maintain knowledge of insurance rejections/denial processing and appropriately post information for collection and follow-up activity.
  • Research and follow up on all correspondence associated with assigned accounts, including EOB's and documentation letters and generate correspondence requesting required information, when necessary.
  • Responsible for all aspects of follow-up and collections, including making phone calls, accessing payer websites. Identify issues or trending and provide suggestions for resolution.
  • Accurately and thoroughly document the pertinent collection activity performed. Review the account information and necessary system applications to determine the next appropriate work activity.
  • Review, investigate, and resolve claims that have been rejected or denied by insurance.
  • Initiate appeals and ensure all required documentation is submitted in the appeal process. Research all denials and follow up as necessary.
  • Verify claims adjudication utilizing the appropriate resources and applications.
  • Receive inbound and place outbound calls to/from insurance companies and patients to collect outstanding funds.
  • Answer patient billing questions and act as a resource for patient billing questions.
  • Initiate telephone or letter contact to patients to obtain additional information as needed.
  • Verify insurance benefits utilizing website, fax, and phone. Knowledge of plan types/builds and how to create within the system.
  • Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic claim submission.
  • Process dental clean claims for payment by all insurance companies to ensure appropriate and timely coding, billing, and collections.
  • Manage and maintain assigned workload, complete reports, and resolve high-priority and aged inventory.
  • Responsible for meeting goals and objectives in assigned areas of revenue cycle operations.
  • Identify problems or improvements within own areas, develop 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.