General Summary:

The Revenue Operations Specialist will be responsible for review and resolution of outstanding insurance balances on Commercial, Medicare and Medicaid accounts. Submitting claims electronically and/or paper. Review and resolve outstanding insurance balances for Commercial, Medicare and Medicaid accounts.

Essential Functions:

1. Effectively manages assigned insurance receivables to achieve company set expectations
2. Submit timely and accurate electronic and/or hardcopy claims
3. Research, process and follow-up on claim denials and appeals in a timely manner
4. Communicates with insurance companies as needed to resolve claim issues
5. Verifies eligibility on AHCCCS and RBHA’s online website, reconciles and updates EMR accordingly.
6. Applies daily deposits in EMR system to appropriate payers. Reconciles balances and follows up with contact

to agencies for payment

1. Audits current claims for errors. Sends errors to providers for corrections
2. Assist in special projects and perform other related duties as needed and assigned

Physical Demands and Work Environment:

The physical demands described here are representative of those that must be met by a teammate to successfully

perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with

disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands

and fingers to operate a computer and telephone keyboard reach, stoop kneel to install computer equipment

• Specific vision abilities required by this job include close vision requirements due to computer work
• Light to moderate lifting is required
• Regular, predictable attendance is required; including quarter-driven hours as business demands dictate.

The work environment characteristics described here are representative of those a teammate encounters while

performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with

disabilities to perform the essential functions.

• Moderate noise (i.e. business office with computers, phone, and printers, light traffic).
• Ability to work in a confined area.
• Ability to sit at a computer terminal for an extended period of time.

Expected Behaviors:

• Standards of Conduct –Consistently demonstrates knowledge of, adherence to, and willingness to promote Touchstone’s Standards of Conduct. · Safety - Follows safety policies, procedures, and Agency approved practices. Exercises good judgment when confronted with safety related decisions. Actions demonstrate that first concern is to ensure the safety of our clients/members, self, employees, community and others (includes but is not limited to driving, work area, and living environment). · Mission - Consistently demonstrates dedication to Touchstone’s mission and vision. Support Touchstone’s philosophy of care and works with others positively and in a caring and compassionate manner. · Ethics - Conducts business in a manner that adheres to established internal and external guidelines and regulations and is regarded by others as one who will always "do the right thing." Uses Touchstone’s resources in a prudent manner. Is alert to potential risks, concerns, and violations, taking action to immediately report concerns to a supervisor or appropriate manager.

Universal Core Competencies:

• Customer Service - Is viewed by others as professional, approachable, friendly, and helpful. Positively represents

the face, the reputation, and the integrity of Touchstone. Demonstrates knowledge of customers (internal and

external) and takes steps to understand and address current needs and anticipate future needs. Is sensitive to the

importance of customer satisfaction, and interactions result in positive outcomes.

• Responsibility - Holds self-accountable for desired outcomes and for meeting expectations. Works diligently to

achieve goals, minimize risk, and take responsibility and ownership of actions, work product, and services

provided. Demonstrates this by completing assignments on time, working independently, and by being dependable.

Gets the job done.

• Respectfulness - Treats others fairly, consistently, and with dignity. Displays personal and professional

boundaries. Uses positive and pro-social interactions. Resolves conflict constructively, directly, and professionally.

Welcomes and accepts the differences in others and works well with others in a diverse environment.

• Team Cooperation - Understands the role on the team and contributes toward its success. Places the team's

interests ahead of your own. Works cooperatively with others and actively listens. Brings new ideas and energy to

the group. Actively supports team decisions once they are made.

• Communication - Readily shares information or knowledge needed by others. Routinely promotes open

communication by seeking and providing feedback. Effectively and appropriately conveys thoughts both verbally

and in writing so that others understand. Uses communication technology effectively, responsibly, and within policy.

• Positive Initiative - Leads and influences others by example. Takes pride in own work and demonstrates a "can

do" attitude while completing assignments and / or when challenged with obstacles. Effectively manages

unexpected events, and acts on opportunities to improve the services that we provide to our customers.

• Professional Development: Ensures training compliance and enhancement of professional skills and career

development.