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Senior Revenue Cycle Analyst
2 months ago
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.
- 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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