Healthcare Revenue Cycle Specialist
1 week ago
We are a prominent private medical practice focused on the diagnosis and treatment of retinal and vitreous diseases. Our organization is seeking a dedicated full-time Revenue Cycle Analyst to enhance our operational efficiency. This role will report directly to the Revenue Cycle Manager (RCM), who oversees the RCM team.
Key Responsibilities:
- Analyze Accounts Receivable (AR) Aging reports to identify and resolve problematic claims.
- Engage with insurance payers to address outstanding claims and ensure timely resolution.
- Provide insights and recommendations to optimize claims processing.
- Evaluate AR credit balances to ascertain refund amounts owed to payers and patients, initiating refunds and adjustments as necessary.
- Support provider and practice credentialing and contracting processes.
- Assist with payer audit requests related to claims.
- Respond to various inquiries from payers, including requests for medical records and updates to provider directories.
- Analyze denial trends and propose strategies to minimize future denials.
- Complete additional tasks and projects as assigned.
- A minimum of 3 years of experience in AR follow-up for physician office visits and diagnostic testing claims.
- Strong analytical and problem-solving skills to effectively address unpaid claims, including the appeal process.
- Proficient in Excel for managing and summarizing extensive data sets (e.g., pivot tables, vlookups, conditional formulas).
- Ability to work autonomously and efficiently.
- Excellent communication and interpersonal skills.
- Experience in payer credentialing and contracting.
- Comprehensive knowledge of full-cycle claims processing, including authorizations, eligibility, coding, and claims follow-up.
- Familiarity with NextGen practice management software.
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