Senior Revenue Cycle Specialist: Collections and Reimbursement

3 weeks ago


Atlanta, Georgia, United States Rose International Full time
Job Summary

Rose International is seeking a highly skilled Senior Revenue Cycle Specialist to join our team. As a Senior Revenue Cycle Specialist, you will be responsible for maximizing reimbursement from various insurance plans by resolving complicated denials, short payments, billing errors, and other claim issues.

Key Responsibilities
  • Work assigned lists of outstanding claim balances and patient accounts with multifaceted issues across different payers and patients.
  • Identify trends, conduct follow-up, and perform root cause analysis on unpaid and underpaid insurance claims across different payers.
  • Perform actions towards remediation of outstanding balances according to policy and procedure; including but not limited to in-depth research, appeals, rebilling, obtaining insurance authorizations or referrals, correcting coding, calling the payer or clinic, and utilizing payor portals.
  • Resolve issues related to a patient's coordination of benefits (COB), demographic discrepancies, insurance eligibility or authorizations, and referrals as needed.
  • Address patient benefit-related denials, including phone verification of plan requirements, financial risk, as well as other factors that may impact reimbursement.
  • Navigate through various payer systems, provider portals, and internal Client applications to ensure timely and accurate claim resolution.
  • Regularly communicate with payers, employers, and patients.
  • Demonstrate ability to build strategic business relationships with internal and external partners (i.e., Billing & Coding Team, Registration Department, Credit Department, clinical teammates, and the payer(s)).
  • Uses exceptional organization, written, and verbal communication skills to produce detailed documentation of research and actions taken on claims.
  • Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and Client policies.
Requirements
  • Proficiency in Microsoft Office tools, including Excel, PowerPoint, Word, and Outlook (required).
  • Experience working in healthcare revenue cycle; emphasis on collections (2+ years) (required).
  • Experience obtaining insurance authorizations and sorting out coordination of benefits (preferred)—knowledge of retro authorizations and referrals is a plus.
  • Ability to confidently communicate with payers, clinics, and patients.
  • High school Diploma or equivalent (required).
  • Associates or Bachelor's degree (preferred).


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