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Senior Revenue Cycle Analyst
2 months ago
Key Responsibilities
The Revenue Cycle Specialist plays a crucial role in managing the financial processes associated with patient accounts. This position requires a comprehensive understanding of the revenue cycle and the ability to thrive in a fast-paced environment. The primary responsibilities include:
- Executing both manual and electronic posting tasks for all payors and patient accounts, ensuring accurate cash balancing and bank deposit reconciliation.
- Correcting payment discrepancies, including transfers and non-sufficient funds (NSF) issues.
- Investigating and resolving unapplied accounts by utilizing established identification processes.
- Analyzing and rectifying errors in insurance accounts receivable and payment posting ledgers.
- Conducting thorough reviews of patient accounts to identify and amend 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, accurately posting relevant information for collections and follow-up.
- Managing all correspondence related to assigned accounts, including explanation of benefits (EOB) and documentation letters, and generating requests for additional information when necessary.
- Handling all aspects of follow-up and collections, including making calls and accessing payer websites to identify issues and trends, providing suggestions for resolution.
- Documenting all pertinent collection activities thoroughly and accurately, reviewing account information to determine the next steps.
- Investigating and resolving claims that have been denied or rejected by insurance companies.
- Initiating appeals and ensuring all necessary documentation is submitted as part of the appeal process, while conducting follow-ups on denials.
- Verifying claims adjudication using appropriate resources and applications.
- Managing inbound and outbound communications with insurance companies and patients to collect outstanding balances.
- Addressing patient billing inquiries and serving as a resource for billing-related questions.
- Contacting patients via phone or letter to gather additional information as needed.
- Verifying insurance benefits through various channels, including websites, fax, and phone, while understanding plan types and configurations.
- Performing necessary billing functions, including manual re-bills and electronic submissions to payers, ensuring compliance with billing guidelines.
- Processing clean claims for dental services to ensure timely coding, billing, and collections.
- Managing assigned workloads effectively, completing reports, and addressing high-priority and aged inventory.
- Meeting established goals and objectives within the revenue cycle operations.
- Identifying areas for improvement within the role and developing innovative solutions to enhance workflow.
- Executing additional duties as assigned by leadership.
- 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 PC skills, particularly in MS Office (especially Excel).
- Excellent interpersonal and organizational skills, with the ability to work collaboratively and independently.
- Strong oral and written communication skills, with a commitment to quality work and meeting deadlines.
- Attention to detail, accuracy, and strong analytical skills are essential.
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