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Senior Revenue Cycle Analyst

2 months ago


Lincoln, Nebraska, United States Paradigm Oral Health Full time

Position Overview

The Revenue Cycle Specialist plays a crucial role in managing the financial processes associated with patient accounts, ensuring accuracy and efficiency in a fast-paced environment. The key responsibilities encompass:

  • Executing both manual and electronic posting tasks for various payors and patient accounts, including cash balancing and bank deposit reconciliation.
  • Processing payment adjustments, transfers, and handling non-sufficient funds (NSF).
  • Investigating and resolving unapplied accounts through established identification processes.
  • Analyzing and rectifying errors in insurance accounts receivable and payment posting ledgers.
  • Conducting thorough reviews of patient accounts to identify and correct discrepancies, including account audits, aging accounts receivable, unapplied adjustments, and resolving credit balances.
  • Ensuring ledger accuracy and maintaining account integrity.
  • Researching payor recoupments to identify errors and opportunities for disputing and recovering lost revenue, as well as validating patient refunds before processing.
  • Maintaining up-to-date knowledge of insurance rejection and denial processes to ensure accurate posting for collection and follow-up activities.
  • Following up on all correspondence related to assigned accounts, including explanation of benefits (EOBs) and documentation letters, and generating requests for necessary information.
  • Handling all aspects of follow-up and collections, including making phone calls and accessing payer websites, while identifying trends and providing suggestions for resolution.
  • Documenting all collection activities meticulously and reviewing account information to determine the next appropriate steps.
  • Investigating and resolving claims that have been denied or rejected by insurance providers.
  • Initiating appeals and ensuring that all required documentation is submitted during the appeal process, along with researching denials and following up as needed.
  • Verifying claims adjudication using appropriate resources and applications.
  • Managing inbound and outbound communications with insurance companies and patients to collect outstanding payments.
  • Addressing patient billing inquiries and serving as a resource for billing-related questions.
  • Contacting patients via phone or letter to gather additional information as required.
  • Verifying insurance benefits through various methods, including online resources, fax, and phone, while understanding plan types and configurations.
  • Performing essential billing functions, including manual re-bills and electronic submissions to payers, ensuring compliance with billing guidelines.
  • Processing clean dental claims for payment from all insurance companies to guarantee timely coding, billing, and collections.
  • Managing and prioritizing assigned workloads, completing reports, and addressing high-priority and aged inventory.
  • Meeting established goals and objectives within the revenue cycle operations.
  • Identifying areas for improvement within processes and developing innovative solutions for operational enhancements.
  • Other responsibilities as assigned by management.
Qualifications and Skills
  • Experience in dental office workflows and revenue cycle functions, including scheduling, registration, insurance verification, fee schedules, claim submission, accounts receivable follow-up, and payment posting.
  • Knowledgeable about reimbursement and compliance processes with various payors.
  • Familiarity with practice management software, insurance portals, clearinghouses, and banking reconciliation software, along with strong proficiency in MS Office, particularly Excel.
  • Excellent interpersonal and organizational skills, with the ability to work collaboratively in a team or independently.
  • Strong oral and written communication skills, demonstrating responsibility for quality work and adherence to deadlines.
  • Demonstrated attention to detail, accuracy, and strong analytical skills.

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