Summary:
The Revenue Cycle Specialist is responsible for billing and collecting payments. This position ensures that all accounts are billed appropriately and meets all regulatory and compliance requirements.
Role and Responsibilities:
Respond to inquiries from insurance carriers, via telephone, email or fax and demonstrate a high level of customer service.
Pursue reimbursement from carriers by placing phone calls and documenting all communication in Athenahealth to ensure progress is made on outstanding accounts.
Identify and respond to patterns of denials or trends and perform complex account investigation as needed to achieve resolution.
Review and resolve uncollected accounts and prepare charge corrections.
Appeal carrier denials through review of coding, contracts, and medical records.
Call insurance companies regarding any discrepancy in payments if necessary
Identify and bill secondary or tertiary insurances
Research and appeal denied claims
Set up patient payment plans
Verify patient benefit eligibility/coverage and research ICD-10 diagnosis and CPT treatment codes as needed
Advise management of any trends regarding insurance denials to identify problems with payers.
Complete required reports and assist with special projects as assigned.
Essential Qualifications:
Education/experience: High School Diploma or General Education Degree (GED) with 3 years prior hands-on experience in a fast-paced medical billing environment. Must have previous experience in a healthcare setting. Familiarity with CPT and ICD-10 is also required; CPC certification is a plus.
Knowledge/Skills/Abilities:
Strong communication, including writing, speaking and active listening
Great customer service skills, including interpersonal conversation
Good problem-solving and critical thinking skills
Organization, time management and prioritization abilities
Ability to be discreet and maintain the security of patient or customer information
Effective computer skills with practice management software
Understanding of industry-specific policies, such as HIPAA regulations for health care
Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid
Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
Effective communication abilities for phone contacts with insurance payers to resolve issues
Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members
Able to work in a team environment
Problem-solving skills to research and resolve discrepancies, denials, appeals
Knowledge of medical terminology
Knowledge of CPT/ICD-10 and modifier coding