Certified Revenue Cycle Representative

JOB SUMMARY:

• The Certified Revenue Cycle Representative is a vital member of the hospital's Business Office/Patient Financial Services team, responsible for managing patient accounts, ensuring accurate and timely billing, and effectively following up on outstanding balances. This role requires a strong understanding of healthcare billing processes, insurance regulations, and excellent communication and problem-solving skills. The representative serves as a key point of contact for patients regarding their financial obligations and works collaboratively with internal departments and insurance payers to optimize the revenue cycle. The ideal candidate will be a certified professional with a commitment to accuracy, compliance, and providing exceptional customer service.

PRIMARY JOB DUTIES:

1. Adheres to Brodstone Healthcare’s Mission, Vision and Values.
2. Adheres to Brodstone Healthcare Standards of Behavior.
3. Review and analyze patient accounts to ensure accuracy and completeness of billing information.
4. Investigate and resolve billing discrepancies, errors, and denials.
5. Follow up on outstanding accounts receivable (A/R) through various methods (e.g., phone calls, correspondence, system worklists).
6. Document all collection efforts and account activity accurately and thoroughly in the patient accounting system.
7. Process patient refunds and adjustments in accordance with hospital policies and procedures.
8. Collaborate with other departments (e.g., Patient Access, Health Information Management, Clinical Departments) to obtain necessary information for accurate billing and collection.
9. Verify insurance eligibility and coverage for patients.
10. Submit electronic and paper claims to insurance payers accurately and timely.
11. Monitor claim status and follow up on unpaid or denied claims with insurance companies.
12. Analyze Explanation of Benefits (EOBs) and remittance advices to identify payment discrepancies and take appropriate action.
13. Initiate and manage the appeals process for denied claims, ensuring all required documentation is submitted.
14. Stay updated on payer rules, regulations, and coding guidelines.
15. Respond to patient inquiries regarding billing statements, insurance coverage, and payment options in a professional and courteous manner.
16. Explain billing procedures, charges, and payment policies to patients.
17. Assist patients with setting up payment plans and exploring financial assistance options.
18. Resolve patient complaints and concerns related to billing issues, escalating complex issues as needed.
19. Maintain patient confidentiality in accordance with HIPAA regulations.
20. Adhere to all federal, state, and local regulations related to healthcare billing and collections.
21. Comply with hospital policies and procedures related to the revenue cycle.
22. Maintain knowledge of current coding (CPT, HCPCS, ICD-10) and billing guidelines.
23. Participate in training and educational programs to enhance job knowledge and skills.
24. Identify and report potential compliance issues or areas for improvement in the revenue cycle process.
25. Utilize the hospital's patient accounting system and other relevant software applications effectively.
26. Generate and analyze basic reports related to assigned tasks and account status.
27. Maintain accurate and organized records.
28. Certification in a relevant revenue cycle field (e.g., CRCR, HBMA).
29. Strong understanding of healthcare billing processes, insurance regulations, and coding principles.
30. Excellent communication, interpersonal, and customer service skills.
31. Proficient in using patient accounting systems and other relevant software.
32. Strong analytical and problem-solving skills.
33. Ability to work independently and as part of a team.
34. Attention to detail and accuracy.
35. Ability to maintain confidentiality Perform other duties related to the efficient operation of the business office as directed by management.
36. Performs other duties as assigned

EDUCATION:

• Required
  • GED or High School Diploma Required

EXPERIENCE:

• None

CERTIFICATE, LICENSE, REGISTRATIONS:

• Required
  • Certified Revenue Cycle Representative (CRCR) within 12 months of employment. 

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