The Patient Revenue Cycle Specialist is responsible for resolving and collecting private-pay accounts. The position requires advanced knowledge of account analysis, payer guidelines, and appeals processes. Key Responsibilities - Manage and resolve assigned inventory, with a focus on private-pay accounts.
- If insurance is located, or at the request of the Director, the “Patient Revenue Cycle Specialist” will initiate assignment of the insurance account to a “Revenue Cycle Insurance Specialist.” Otherwise, the “Patient Revenue Cycle Specialist” will analyze and follow up on unpaid or denied claims with commercial, government, and other third-party payers. The “Patient Revenue Cycle Specialist” is expected to prepare and submit appeals, reconsiderations, and supporting documentation in accordance with payer requirements.
- Meet established production goals for private pay fee requirements.
- Identify reason(s) for non-payment and take corrective action.
- Work on private pay accounts as assigned to completion.
- Maintain accurate and timely documentation of all account activity in compliance with company policies and procedures.
- Collaborate with coding, billing, and data processing departments to resolve discrepancies.
- Meet established productivity, quality, call auditing, claim auditing, and compliance standards.
- Stay current on payer regulations, billing guidelines, and applicable healthcare laws.
Qualifications - High school diploma or equivalent.
- Experience with medical collections and insurance filing/follow-up preferred, but NOT REQUIRED.
- EOB knowledge and interpretation.
- Experience with high-dollar claims and appeals.
- Proficiency in EPIC and Microsoft Office applications.
Skills and Competencies - Critical thinking skills and analytical thinking.
- Effective writing and verbal communication.
- Attention to detail and accuracy.
- Ability to manage sensitive financial information with confidentiality.
Compliance Statement Must comply with all applicable federal, state, and local laws and regulations, including but not limited to: HIPAA, FDCPA, and payer-specific guidelines, as well as company policies and procedures. Our Employment Practices Diversified HealthCare Services, Inc. is an equal opportunity employer. We value the different abilities, experiences and perspectives individuals bring to our organization and recognize that these differences strengthen our company and the service we provide for our clients. Applicants for our positions are considered without regard to race, ethnicity, national origin, sex, sexual orientation, gender identity or expressions, age, disability, religion, military or veteran status, or any other characteristic protected by law. Diversified HealthCare Services, Inc. maintains a drug-free and smoke-free workplace. Employment is contingent upon successful completion of applicable pre-employment requirements, including a drug screen and a background check.
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