Revenue Cycle Specialist

5 days ago


Middle Island, United States M&D Capital Premier Billing Full time

Job Title: Medical Billing Revenue Cycle Management Specialist

Job Summary: We're looking for a skilled Medical Billing- Revenue Cycle Management specialist to join our team in Middle Island, NY. As a key member of our medical billing team, you'll be responsible for ensuring accurate and timely follow-up on billed claims.

Responsibilities:

  1. Claims Follow-up: Responsible for following up on claims from submission to final payment.
  2. Insurance Company Communication: Communicate with insurance companies regarding claim denials or underpayments.
  3. Payer Portal Utilization: Utilize Payer Online Portals such as Availity, Cignaforhcp, UHC, Navinet, and Emblem for claims status and eligibility verification.
  4. Medical Record Management: Send Medical Records to payers, file reconsiderations and appeals, and utilize providers' EMRs to obtain Medical Records.
  5. Payer EOB Understanding: Reading and understanding various payers EOBs.
  6. Payment Processing: Posting payments, writing off balances, and sending statements to patients when necessary.
  7. OON Claim Negotiation: Communicating with 3rd party payers such as Multiplan, MARS, and Zelis regarding OON claim negotiations.
  8. Pre-negotiated Agreement Follow-up: Follow up on Pre-negotiated Agreements a/k/a Single Case Agreements.
  9. Billing Data Accuracy: Review and verify accuracy of billing data utilizing Optum EncoderPro.
  10. Medical Collection Systems: Utilize medical collection systems to track and collect payments.
  11. Coding and Billing Regulations: Ensure compliance with all relevant coding and billing regulations.
  12. Complex Issue Resolution: Effectively resolve complex issues, including payment research and recoupments.
  13. Issue Communication: Effectively communicate issues to management, including payer, system, or escalated account issues as well as develop solutions.

Requirements:

  • Multi-Specialty Coding Knowledge: Knowledge in Multi-Specialty coding - CPT and ICD codes for many different specialties.
  • Medical Billing Software Experience: Experience working with medical billing software like Imagine and ADS.
  • Familiarity with Payer Processes: Familiar with Gap (Network Deficiency) exception and prior authorizations process.
  • Federal IDR Arbitrations Process: Familiar with Federal IDR arbitrations process.
  • OON Provider Registration: Familiar with OON Provider Registration Process with various Payers.
  • Medical Terminology Knowledge: Knowledge of medical terminology (Hicfa, UB04, Tax ID, NPI).
  • Attention to Detail and Persuasive Skills: Strong attention to detail and persuasive telephone skills.
  • Communication and Interpersonal Skills: Excellent communication and interpersonal skills.
  • Microsoft Office Skills: Solid skill with Microsoft Office applications: Word, Excel, Teams, Power BI reporting, Zendesk.
  • Education: High School Diploma or equivalent.
  • Experience: Must have a minimum of 3 years' experience in collections.

Benefits:

  • 401(k) Plan: Employer-matched retirement plan.
  • Dental Insurance: Comprehensive dental insurance plan.
  • Health Insurance: Affordable health insurance options.
  • Life Insurance: Group life insurance coverage.
  • Paid Time Off: Generous paid time off policy.
  • Vision Insurance: Vision insurance coverage.


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