Revenue Cycle Specialist

2 days ago


Lafayette, Louisiana, United States Oceans Healthcare Full time
Job Summary

Oceans Healthcare is seeking a highly skilled Revenue Cycle Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for ensuring accurate and timely billing and collection of outstanding receivables from third-party payers and payer representatives.

Key Responsibilities
  • Claims Review and Submission: Review third-party claims for accuracy and completeness using patient accounting functionality and submit claims to third-party payers within timely filing restrictions.
  • Follow-up Activities: Perform follow-up activities by telephone or electronic inquiry on accounts with outstanding third-party payer balance to determine the status of claims in accordance with payer-specific follow-up guidelines.
  • Claim Adjudication: Attempt to expedite claim adjudication by resolving issues that may delay processing, involving the patient/guarantor as necessary.
  • Documentation and Resubmission: Clearly and concisely document pertinent follow-up activity upon completion of each occurrence in the patient accounting system and resubmit claims to payers as necessary.
  • Account Balances and Reporting: Ensure accurate account balances for proper account processing and reporting, requesting contractual allowances, adjustments, and balance transfers as necessary.
  • Communication and Collaboration: Communicate with other revenue cycle staff members, Utilization Review/Case Management, and site leadership to ensure timely and accurate claims payments.
  • Credit Balance Research and Resolution: Research and resolve credit balance accounts as requested by payers or as identified on aging reports.
  • Productivity and Performance Reporting: Complete daily and weekly productivity/performance reporting as directed by management.
Requirements

To be successful in this role, you will need to have excellent communication and organizational skills, as well as the ability to work in a fast-paced environment. You will also need to be proficient in patient accounting systems and have a strong understanding of revenue cycle processes.



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