Medical Revenue Cycle Specialist

3 weeks ago


Atlanta, Georgia, United States NextGen Healthcare Full time
Job Summary

We are seeking a highly skilled Medical Revenue Cycle Specialist to join our team at NextGen Healthcare. In this role, you will be responsible for performing revenue cycle management activities for assigned patient and insurance accounts. You will assist colleagues and global partner teams with assignments and escalations related to their RCM department, while ensuring that daily, weekly and monthly tasks are accomplished effectively and in a timely manner. The ideal candidate will have 2-4 years of experience in medical billing and/or collections in a healthcare or insurance environment and possess a strong understanding of healthcare carriers and payer requirements.

Key Responsibilities
  • Claims Management
    • Perform and collaborate with global partners to ensure timely claims submission for clients.
    • Collaborate with technology vendors supporting claims management.
    • Generate relevant reporting for management and clients on claims submission and SLA adherence.
  • Coding and Credentialing
    • Review and/or audit patient charts to confirm HCPCS and ICD codes are appropriately assigned and sequenced according government regulations and insurance payer guidelines.
    • Verify provider documentation accurately supports the diagnoses, services, and treatment as billed on the patient's encounter.
    • Utilize AAPC, Encoder Pro, and other medical coding resources to identify and confirm accurate codes for claims submission.
    • Collaborate with client to identify documentation inefficiencies and educational opportunities for providers to ensure timely and accurate medical charting.
  • Insurance AR and Patient Services
    • Review and/or audit accounts to determine status and appropriate action required.
    • Research and follow-up on denials and requests for additional information.
    • Receive, research, and respond to correspondence from insurance companies, attorneys, and patients.
    • Use facility correspondence websites, phone, and/or correspondence to contact payers regarding reimbursement for unpaid accounts.
    • Identify, verify, and document account adjustments according to established policies and procedures.
  • Payments and Benefits
    • Post payments and adjustments received from insurance carriers, patients, and collection agencies with accuracy and efficiency while utilizing the appropriate fee schedule/policy.
    • Review and interpret explanation of benefits (EOB) from insurance carriers to post appropriate payment and denial codes.
    • Identify incomplete information necessary to post remittance and take the necessary steps to resolve questions, inconsistencies, or missing data.
Requirements
  • Education
    • High School Diploma or General Educational Development (GED).
  • Experience
    • 2-4 years of experience in medical billing and/or collections in a healthcare or insurance environment.
  • License/Certification
    • Coding
      * Certified Coding Specialist (CCS-P), Certified Professional Coder (CPC), or Certified Coding Associate (CCA), required from AHIMA or AAPC; or licensure equivalent.
  • Skills and Abilities
    • Knowledge of healthcare carriers and payer requirements.
    • Knowledge of Microsoft Office Suite (Word, Excel, Outlook and PowerPoint) with intermediate skill level.
    • Knowledge of Windows based programs.
    • Knowledge and understanding of practice management software.
    • Effective communication with cross-functional team members, peers, and management.
    • Providing customer service to internal and external clients.
    • Problem solving, analytical, and critical thinking.
    • Working as a member of a team.
    • Communicating clearly, concisely, and effectively.
    • Establishing and maintaining effective working relationships.
Compensation

The estimated salary for this role is $65,000 - $85,000 per year, depending on experience and qualifications.

NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.



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