Revenue Cycle Specialist

Job Summary and Objectives

Under the general supervision of the Director of Revenue Cycle Operations, the Revenue Cycle Specialist participates in all aspects of insurance submissions and AR follow-up while adhering to HIPAA compliance, privacy, and confidentiality standards.

Essential Responsibilities and Tasks

• Demonstrate knowledge of timely filing deadlines, payer appeals, and researching payer policies.
• Manage follow-up work queues.
• Resolve patient billing and insurance concerns received via voicemail messages and e-mail.
• Communicate with patients as needed to resolve denials and pending claims.
• Generate patient correspondence to be transmitted through mail or electronically.
• Submit outbound referrals
• May assist with insurance communication, revenue cycle collections, claim edits, charge entry, cash research, as needed.
• Review data on insurance explanation of benefits (EOB’s) to ensure accurate payment posting.
• Completing secondary crossover (Electronically or On Paper).
• Updating the correct payor and resubmission of claim(s)
• Access necessary online portals to obtain payment documentation.
• Identifies any payments not being paid at the allowed/contracted amount and communicates this to the appropriate RCM leadership personnel – Team Lead, Supervisor, Manager
• Submit and maintain correspondence as requested and required to ensure payment is received.
• Assist other projects as needed.
• Maintain accurate and thorough records.
• Demonstrate the ability to act as a team player in a professional and positive manner.
• Perform other duties as may be assigned by the Manager, Revenue Cycle.

· Participate and engage in an Interactive process with other team members and Supervisors

· Adhere to All Applicable Policies and Procedures.

· Clearly Articulate Operational Problems and Positively Contribute to Solution Development

Required Competencies and Skills

§ Excellent interpersonal and customer service skills

§ Excellent verbal and written communication skills

§ Excellent attention to detail

§ Strong Office Skills such as Typing and Filing

§ Advanced Understanding of frequently used Microsoft Office software such as Word, Outlook, and Excel.

§ Strong Understanding of various insurance plans

§ Strong understanding of Healthcare Terminology

§ Ability to work independently on assigned tasks as well as to accept direction on given assignments.

§ Deals with confidential information and/or issues using discretion and judgment.

§ Ability to identify and resolve team issues.

§ Ability to be proactive and take initiative.

Working Conditions and Physical Requirements

§ Frequently adjusts or moves items weighing up to 50lbs across office for various needs.

§ The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.

§ Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, computer, phone.

§ The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.

§ Constantly remaining in a stationary position. Standing or Sitting for Prolonged Periods

§ Must be able to wear personal protective equipment, such as KN95 masks most of the day

§ Must have Sufficient Ambulatory ability to move to various locations.

Education and or Experience Requirements

§ Undergraduate Degree in Relevant Field (Required)

§ Graduate Degree in Relevant Field (Preferred)

§ 1 Years or More of Demonstrated Skill in Similar Position (Preferred)

§ 3+Years of More Experience in Revenue Cycle Department (Required)

§ CPC Certification (Preferred)

§ Internal candidate: No disciplinary documentation in the last 6 months, satisfactory attendance, satisfactory team attendance/proper progressive discipline on file.

Other Requirements

§ Valid California Driver’s License

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