What are the responsibilities and job description for the Revenue Cycle Operations Specialist position at AllCare Georgia?
Description:
Are you a detail-oriented professional with a passion for healthcare operations and revenue cycle management? Join our team as a Revenue Cycle Operations Specialist and play a key role in streamlining processes, improving claim accuracy, and supporting patient and provider communications.
Credentialing & Enrollment
- Manage Medicare and Piedmont provider credentialing and location updates.
- Research and facilitate enrollment for miscellaneous insurances.
- Maintain CAQH profiles and update provider credentials in Athena.
Coding & Documentation
- Collaborate with Omega weekly to resolve coding queries.
- Audit coding accuracy and research payer requirements.
- Review provider documentation and modifier holds for timely filing.
Claims & Holds
- Process an average of 50 holds daily, including coding and credentialing.
- Review Explanation of Benefits (EOBs) and adjust patient balances.
- Create claims for self-pay and late cancellation/no-show fees.
Patient Communication
- Respond to patient emails and biller inbox inquiries.
- Escalate billing complaints and provide weekly collection call lists.
Reporting & A/R
- Prepare weekly revenue cycle and goal update reports.
- Review outstanding A/R and follow up with insurance and patients.
- Conduct payment research and process refunds.
Special Projects
- Maintain fee schedules, allowed amounts, and Athena cases.
- Monitor payment mismatches and communicate with Mindoula on denied claims.
Meetings & Collaboration
- Participate in weekly and monthly meetings with internal and external teams.
- Support cancellation tracker reviews and insurance accuracy audits.
What You Bring
- Bachelor’s degree in Finance, Healthcare Administration, or equivalent experience.
- 5–7 years of experience in healthcare revenue cycle management.
- Athena experience required; CAQH familiarity preferred.
- ICD-10 Certification.
- Strong knowledge of billing, coding, and compliance.
- Excellent analytical, organizational, and communication skills.
- Sign on bonus at the end of 90 days dependent on knowledge
