Revenue Cycle Medical Billing Specialist

The Revenue Cycle Medical Billing Specialist is responsible for the overall account resolution of patient accounts within the revenue cycle management (RCM) process. Ensures timely billing of claims to payers and follow up of denials, appeals, recoupments and balance management. Ability to audit and provide feedback on the billing process and outcomes. Works cooperatively with other departments to ensure timely billing, reporting and patient account management. Supports the organization’s strategic plan and workplace inclusion initiatives. Abides by the organization’s mission in performing job duties. Demonstrates an understanding and commitment to PPGT’s culture of quality, safety and risk awareness.

• Reviews submission of claims by third party billing team to the clearinghouse to ensure accuracy.
• Processes reimbursements and payment adjustments with attention to detail, timeliness, and accuracy.
• Makes corrections and prepares appeals related to claim denials within the department’s established timelines.
• Monitors and reviews patient and commercial payer payment postings by the third-party revenue team.
• Prepares reports to monitor and track clean claims submissions as required.
• Maintains open, ongoing communication with other departments (i.e. Finance, Patient Access Center, Health Services), answering questions and providing guidance as necessary.
• Reviews and tracks payments and reports for unusual denial or non-payment trends and escalates these trends with supervisor.
• Monitors accounts receivable (A/R) aging claims, creates and reviews reports and researches unpaid claims for collectability - correcting and/or refiling claims as applicable.
• Assists with completion of billing audits and monthly reports to identify trends, underpayments, adjustments, refunds, and payment posting by third party billing team.
• Maintains accurate medical billing and claim records, documenting revenue from patients’ payments and insurance reimbursements.
• Assists with claim status updates, appeals, credit balance reviews, refunds and account resolution, ensuring a high level of accuracy in documentation in the organization’s electronic practice management (EPM) system.
• Assist patients as needed to resolve patient balances. Ensure patient messages and inquiries are returned within 1-2 business days.
• Tracks and trends correspondence and returned mail volume and updates patient account demographics with new address, returned mail indicator, and billing alerts as they occur.
• Reviews patient statement files submitted by third party billing team and follows up to resolve issues within the statement file process within the department’s established timelines.
• Works closely with the Clinical Applications team to ensure optimal use of the EPM system, clearinghouse and payer portals.
• Provides support to health center staff regarding daily patient account and cash balancing questions.
• Promotes and exemplifies a high performing patient access culture that embraces the organization’s workplace values of respect, caring, support, effective communication, teamwork, collaboration, accountability, and responsibility; and works with staff to create and maintain a workplace environment reflective of these values.
• Has unrestricted access to paper and electronic patient protected health information (PHI) and health records for purposes of treatment, payment, and/or healthcare operations. The use of a patient’s protected health information should be limited to information needed for the specific task that is being performed or requested by the individual patient. Disclosure of any patient information must be for purposes of treatment, payment or healthcare operation OR must be accompanied by a valid patient authorization. Must adhere to minimum necessary rule.
• Embraces the organization’s “In This Together” customer service standards and uses them with internal and external customers, every person, every time. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, either verbally or in writing.

High School diploma or equivalent + 2 years of relevant experience or Associate’s or Bachelor’s degree + some relevant experience. Relevant experience: Medical Billing, Medical Coding, Accounts Receivable experience. Medical Billing experience and electronic patient management (EPM) system experience preferred.

Medical Billing and Coder Certification(s) preferred.

Must be able to work primarily with fingers such as picking, pinching, or typing. Must be able to talk such as convey detailed or important spoken instructions to other workers accurately. Must be able to hear such as the ability to receive detailed communication orally. Must be able to communicate effectively. Will have substantial movements of the wrists, hands, and/or fingers. Must be able to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Sedentary/Office environment.

• Must be able to work the organization’s hours of operation or as required.
• Ability to successfully handle high volume of accounts.
• Ability to exercise initiative, sound judgment, and problem-solving techniques in the decision-making process.
• Ability to think strategically and achieve organization’s goals relating to position.
• Ability to provide oversight of compliance and regulatory requirements pertaining to position.
• Strong organizational skills and ability to multi-task.
• Ability to effectively use organization’s computer systems.
• Ability to manage details and complexity, to handle a variety of tasks simultaneously, and work under pressure.
• Skilled in verbal and written communications.
• Be discreet and safeguard confidential information.
• Possess integrity and compliance – can be relied upon to act ethically.
• Ability to provide effective, equitable, understandable, and respectful quality care and services that are responsive to the diverse cultural health beliefs and practices, preferred language, health literacy and other communication needs.
• Ability to work effectively as a team member.
• Organizational Awareness: Demonstrates a comprehensive awareness of the impact and implications of decisions and actions on other areas (departments or clinics) within the organization.
• Work Management: Effectively manages time as a resource; establishes realistic priorities; schedules own time and activities effectively; gives balanced focus and attention to appropriate long- and short-term priorities. Develops action plans and budgets; leverages technology; anticipates obstacles; establishes check points and monitors progress.
• Building Relationships: Shows genuine interest in others’ needs and opinions; establishes rapport; earns the confidence and trust of others; demonstrates consistency between words and actions; delivers on commitments.
• Process Improvement: Understands core work processes; identifies process opportunities and issues; seeks information to understand the gap between current and desired performance; works effectively with others to identify and implement improvements; continuously works to improve returns for the client and the organization.
• Exemplify the organization’s In This Together values: We Tend to the Team; We Respect and Honor All People; We Jump In; We Try and We Learn; We Care for our Business; and We Return to our Mission.

Must have excellent computer skills with knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Internet. Must have the willingness and ability to adapt to change including advances or new technology. Must have excellent customer service skills and be committed to providing the highest level of customer satisfaction. 

Other

PPGT is an equal opportunity employer.  We strictly prohibit unlawful discrimination of any kind, including discrimination on the basis of age; race, color, ancestry, national origin, or ethnicity; citizenship status; sex or gender; gender identity or gender expression or transgender status (including the individual's actual or perceived sex and the individual's gender identity, self-image, appearance, behavior, or expression); sexual orientation (including actual or perceived heterosexuality, homosexuality, bisexuality and asexuality); mental or physical disability; AIDS, AIDS Related Complex, or HIV status; perception of risk of HIV infection; or association with individuals who are believed to be at risk; religion or creed; genetic information; pregnancy status, including related medical conditions; marital status; past, current, or prospective service in the uniformed services; or any other basis protected by law.  We are a drug-free and tobacco-free workplace.

Applicants have rights under the Federal Employment Laws. To view these notices, please click on the following links: Family and Medical Leave Act (FMLA) poster: Equal Employment Opportunity (EEO) poster; and Employee Polygraph Protection Act (EPPA) poster.