GENERAL PURPOSE:

Under the general supervision of the PFS Director, the Revenue Cycle Specialist will be cross-trained in order to assist in supporting the team and perform various complex functions related to the revenue cycle operations. This will involve refining existing processes related to revenue cycle activities and supporting overall revenue cycle goals. This position will provide coverage and serve as a temporary resource in various areas of the revenue cycle.

ESSENTIAL FUNCTIONS:

Must be able to work under sustained pressure and during stressful situations. This role will perform responsible and moderately complex mid-level duties by overseeing and troubleshooting billing and/or revenue cycle claims that reduce denials and impact accounts receivables. The Revenue Cycle Specialist provides patient revenue management support throughout the business office, to include but not limited to Billing and Collections, Cash Management and Payment Posting, Financial Counseling, Charge Capture and Credit Balance Review.

DUTIES AND RESPONSIBILITIES:

Biller/Collector:

· Review billing and claims daily for accuracy and completeness as listed on the Claims Submitted by Health Plan Report and Designated Work Queue; submit claims to proper insurance entities.

· Contacts insurance companies to resolve payer issues, expedite claim processing, and maximize medical claim reimbursement through both oral and written communication.

· Documents all account related activity clearly.

· Identify opportunities to reduce denials.

· Works with the business office team to meet/exceed AR aging benchmarks.

· Able to exercise initiative and good judgment.

Cash Poster:

· Download ERA’s and EFT payments each morning for cash posting.

· Reconcile payer takebacks that can span over multiple remittances which can require a tracing of credits

· Accurately tracks and record payments received without remittances that require a reconciliation process for those outstanding items.

· Reconcile, balances deposit slips, check tape and reports on daily basis.

· Post cash daily, corrects and applies patient and insurance payments including all bill types and corresponding contractual adjustments to patient accounts.

· Posts and flags any EOBS with a zero payment (denial), highlight the zero payments and distribute to the appropriate Patient Account Representative for follow-up.

· Flag any EOBS that will need a secondary claim

· Follows up on any credit balances both patient and insurance refunds as per credit balance policy.

· Post NSF and interest charges.

· Lists unidentified payments to correct suspense account, documenting transactions to maintain adequate audit trail.

· Resolves misdirected payments and returns incorrect payments to sender.

· Corrects and posts debit/credit adjustments of misapplied payments to ensure accurate and timely reporting of accounts.

· Audits, corrects and balances ERA transactions.

· Answers patient inquiries regarding account balances.

Charge Auditor:

· Identifies researches and analyzes charge errors and/or omissions.

· Works with appropriate staff/team members to request missing/required information.

· Ensures that revisions/corrections are entered into the billing program in a timely manner.

· Releases charges from the work queue as completed on a daily basis.

· Meets productivity and net revenue monthly goals.

Financial Counselor:

· Ability to understand and interpret hospital bills and Explanations of Benefits(EOB)

· Understands insurance terms (i.e. HMO/PPO, EOB, stop loss, deductibles, co insurance, etc.) and payment methodologies.

· Communicates with patients and insurance companies on the phone or in person

· Educate patients about payment options, financial assistance and charity care

· Review and process patient and insurance company payments, reconcile according to facility contract

· Appropriately document and report payment information.

SKILLS AND ABILITIES REQUIRED:

1. Uses critical thinking to identify issues and work on solutions

2. Must possess computer skills and knowledge of MS Office, online insurance, online vendor applications, and other office equipment required for this position.

3. Demonstrates the ability to effectively communicate verbally and in writing.

4. In depth knowledge of Medical and Insurance terminology.

5. Strong knowledge of insurance benefits, revenue cycle procedures, coding, claim requirements, interpretation of RA’s/EOB’s for denials and partial payments, claim resubmission, corrections and appeals.

6. Must be able to work independently with minimal supervision, showing initiative and being a self-starter.

7. Must have a technical, systematic and goal driven attitude with the ability to multi-task and prioritize needs to meet required timelines.

EDUCATION AND EXPERIENCE REQUIRED:

1. High School Graduate, college preferred.

2. Familiar with CAH billing practices and reimbursement preferred

3. Analytical Skills required to read, understand, identify and perform functions

4. Must have a minimum of five years’ experience with strong Government and Non-Government hospital or healthcare billing and collections. Strong understanding of insurance plans to include policies and coverage.

5. Must be proficient with using and learning financial and business systems, conducting transaction processing, problem research and resolution

6. Strong knowledge of CPT codes and ICD10’s

7. Understand and Interpret Insurance Verification Benefits

8. Familiar with Medicaid FFS, and Clark County Applications

9. The ability to read and interpret Managed Care Contracts

Job Type: Full-time

Pay: $20.00 - $24.00 per hour

Work Location: In person