Claim Reconciliation Specialist

Description:

GENERAL SUMMARY

The Claim Reconciliation Specialist is responsible for monitoring the claim reconciliation process and identifying issues and process improvement opportunities within the Mid-Revenue Cycle. The position is responsible for revenue leakage root cause analysis and resolution recommendations. This role supports the revenue cycle workflows, charge capture, and work queue processes. This position will help optimize Revenue Cycle by evaluating, validating, and trending data for presentation to all levels of the organization. This role reports to the Coding Supervisor and will work closely with the Coding and Revenue Integrity Manager.

ESSENTIAL JOB FUNCTION/COMPETENCIES

Responsibilities include but are not limited to:

Monitors scheduling and revenue reports for all practice locations to ensure all charges are entered timely and appropriately according to charge reconciliation policy standards.
Monitors practice adherence to charge reconciliation processes.
Works Missing Encounter Report to identify missing charges and ensure they are posted timely and accurately.
Runs surgery schedule weekly and monthly to ensure all scheduled surgeries and related charges have
been billed.
Monitors late charges and write-offs by reviewing reports weekly to determine root causes for late charges.
Maintains charge screens and department charge master files.
Provides feedback to Coding and Revenue Integrity Manager on consistent basis for those
providers/clinicians/practices that are not meeting charge entry standards.
Performs quantitative and financial analysis from daily audit findings as it pertains to charge capture.
Provides estimated revenue impact from audit findings to leadership.
Works with Revenue Integrity Team, Clinical Operations and RCM (Revenue Cycle Management) staff to implement corrective actions to ensure compliant charges, prevent future rejections/denials and accurate and reimbursement.
Responds to queries regarding charges.
Participates in ongoing coordination and resolution of revenue issues as they arise. Assists in troubleshooting and resolving issues related to the patient mid-revenue cycle and assists in development and recommendations.
Performs other position related duties as assigned.
Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.
Requirements:

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

Coding and/or Physician Billing Certification, preferred.

KNOWLEDGE | SKILLS | ABILITIES

Demonstrates understanding of business and how actions contribute to company performance.
Demonstrates excellent customer service skills.
Knowledge of medical terminology, Current Procedural Terminology (CPT), International Classification
of Disease (ICD) coding, and the entire revenue cycle process.
Knowledge of EHR (Electronic Health Record) software systems and Microsoft Office products.
Excellent verbal and written communication skills.
Skill in using computer programs and applications including Microsoft Office.
Must be comfortable educating staff members.
Ability to handle multiple tasks with excellent problem-solving skills.
Strong analytical skills with ability to make conclusions and recommendations.
Well organized with the ability to maintain accuracy and confidentiality.
Ability to work collaboratively across disciplines and business lines.
Ability to develop reports and create presentations.
Ability to work independently and manage deadlines.
Complies with all health and safety policies of the organization.
Complies with HIPAA regulations for patient confidentiality.

EDUCATION REQUIREMENTS

High School Diploma or equivalent required.

EXPERIENCE REQUIREMENTS

Minimum of three years’ revenue cycle experience within a physician practice.
Experience in Urology or physician practice environment preferred.

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