Revenue Cycle Specialist

The Revenue Cycle Specialist is responsible for providing top-notch billing services while ensuring accuracy and efficiency in managing inpatient claims.

1. Prepares and submits billing data and medical claims to insurance companies, ensuring accurate coding.
2. Ensure the patient's medical information is accurate and up to date.
3. Post payments to the system, review Electronic Remittance Advice (ERA) for accuracy, and alert the AR follow-up team of any denials.
4. Report trends in denied claims or payment discrepancies to Business Office management.
5. Accurately bills inpatient medical claims within established timelines and initiates dialog with payors, patients and departments.
6. Reviews billing documents as assigned for submission to insurance plans and government entities (Medicare, Medicaid, Tricare etc). Clearing all edits necessary for clean claim submission.
7. Understands payor contracts and can apply calculations to resolve under/overpayments.
8. Submits reconsiderations and appeals related to denials using payor documentation and portals.
9. Interacts with third party payors and patients to resolve account balances.
10. Escalates claims to proper management personnel when unable to achieve clean claim status for submission.
11. Reviews EOB's/RA's (Explanation of Benefits and Remittance Advice documents received from insurance payers and government entities.
12. Processes all required payments, adjustments to accounts when claim payment is received if required in client or company systems.
13. Contact insurance plans and governments entities using online systems, email, and phone to resolve unpaid claims.
14. Independently responds timely and accurately to all requests. Interacts professionally and courteously with employees and internal and external stakeholders.
15. Effectively monitors assigned work queues and workload, ensuring resolve of accounts in a timely and accurate manner.
16. Performs other duties as assigned.