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Revenue Cycle Specialist

2 months ago

Allentown, Pennsylvania, United States St. Luke's University Health Network Full time


At St. Luke's University Health Network, we take pride in the dedication, expertise, and compassion of our workforce. Our employees are our greatest asset, committed to fulfilling our mission of providing exceptional care to those in need, educating healthcare professionals, and enhancing access to medical services for all individuals, regardless of their financial situation.

The Accounts Receivable Specialist I plays a crucial role in managing the billing and collection processes for St. Luke's services, including both hospital and professional fee billing for our physician group. This position is essential for ensuring the accurate and prompt submission of claims to various payers, in line with established policies.

KEY RESPONSIBILITIES:

  • Efficiently process all UB04 and HCFA-1500 claims through the designated billing system, utilizing the claims scrubber to ensure completeness and accuracy, thereby maximizing reimbursement potential.
  • Adhere to scheduled duties while prioritizing tasks to ensure timely claim submissions and optimize cash flow.
  • Verify the accuracy of billing information and make necessary adjustments as required.
  • Identify and communicate any trends in claim submission issues to the management team.
  • Develop and maintain a foundational understanding of third-party billing requirements, including those from federal, state, and commercial payers.
  • Manage accounts receivable by investigating and reviewing claims in accordance with productivity standards set by management.
  • Analyze daily aging reports of insurance accounts to determine appropriate follow-up actions for non-payment and delayed payment cases, ensuring compliance with all relevant policies.
  • Investigate denied claims to understand the reasons for denial and take appropriate actions to resolve these issues.
  • Work towards resolving problematic accounts and discrepancies in payments to achieve accurate payments and maximum reimbursement.
  • Monitor claims resolution, appeals, and corrections through payer websites whenever feasible.

PHYSICAL AND SENSORY REQUIREMENTS:

This role requires sitting for extended periods, with continuous use of hands for data entry and occasional lifting of light objects. The position also involves frequent bending and reaching to retrieve files, as well as normal hearing and vision capabilities.

EDUCATION:

A High School Diploma or equivalent is required, with a preference for candidates holding a Medical Billing/Coding Program certificate.

TRAINING AND EXPERIENCE:

  • Proficiency in speaking, reading, and writing in English is essential.
  • Strong verbal and written communication skills are required.
  • Experience in third-party billing within a hospital or similar medical environment is preferred.
  • Direct experience with Microsoft Office Suite and web-based applications is necessary.

WORK SCHEDULE:

This position typically follows a Monday to Friday schedule during daytime hours, with no night, holiday, or weekend shifts. Flexible start times may be available after initial training, with remote or hybrid options possible after a designated training period at the discretion of management.

We encourage candidates to submit their applications with complete and accurate information regarding their employment history and qualifications. Thank you for considering a career with St. Luke's University Health Network.



St. Luke's University Health Network is an Equal Opportunity Employer.