REVENUE CYCLE SPECIALIST II

Revenue Cycle Specialist II

Summary/Objective:

The Revenue Cycle Specialist II is responsible for overseeing the revenue cycle activities between Galen Medical Group and RCM Support Team (which is our external billing company).  The Revenue Cycle Specialist II will also assist with coding and auditing functions.

Essential Functions:  

• Coordinates all functions of the external RCM support team to ensure IKS, site, and their assigned tasks are completed in an efficient and timely manner.
• Monitors assigned AR to ensure claims are refiled properly and timely.
• Analyses reports for trends and workflow issues related to assigned AR.
• Works with RCM support team to ensure projects and meetings are productive and complete.
• Work with Management team and Providers to make sure their concerns are answered.
• Assist RCM Support as needed with coding corrections etc.
• Answer CSR phone calls as needed to address patient questions regarding their account.
• Monitor assigned sites to make sure RCM process is flowing smoothly, charges are going out, denials are worked, etc.
• Make recommendations for any improvements in workflow, denial management, etc.
• Review Waystar rejections weekly for denial trends and notify appropriate dept/staff of issues.
• Verifies data in medical chart for completeness and accuracy in regard to appropriate coding regulations and ethics.
• Reviews insurance explanation of benefits for procedures to ensure appropriate reimbursement.
• Monitors reimbursement of selected procedures on a continual basis.
• Make recommendations for any improvements in operation of the medical records or coding department.
• Attend appropriate seminars and meetings regarding coding education and practices
• Review and maintain on a continual basis all bulletins and correspondence from carriers for up-to-date information.

Other Duties/Responsibilities:

• Exhibit a high-level production by assuring all assigned tasks are corrected and rebilled in a timely and helpful manner. 
• Assures external RCM support staff duties and tasks are completed in a timely and accurate manner:

1. Appropriate personnel are notified upon completion of assigned tasks. (coding, billing issues and workflow).
2. Review with Management team and providers that all rejections or denials for demographic, coding and insurance information are obtained, updated, and entered accurately into the practice management system (PM), and eligibility has been done on presented insurance information.

• Knowledge of participating insurance plans accepted by the office.
• Actively participate in process improvement efforts. 
• Serve as a liaison between the external RCM team and onsite teams
• May be required to assist other team members based on office demands.   
• Must always adhere to HIPAA guidelines to maintain the highest level of patient confidentiality. 
• Other duties as assigned by the Revenue Cycle Manager.

Knowledge/Skills/Abilities:

• Promote the mission, vision, and values of Galen Medical Group.
• Maintain confidentiality of all patients’ medical, financial, and legal information.
• Report to work on time and as scheduled.
• Wear identification during work hours.
• Represent the organization in a positive & professional manner.
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner.
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude.
• Comply with all organization policies and standards regarding ethical business practices.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services as directed by your manager.
• Consistently demonstrate the value of team concept.
• Ability to manage multiple and simultaneous responsibilities.
• Complete assignments efficiently and in a timely manner.
• Understands and abides by OSHA, HIPAA & CLIA standards.

Qualifications:

Education:

• High school graduate or equivalent.
• Certification in Coding.

Experience:

• Prefer individual with two to three years’ medical billing, coding, A/R collection experience.
• Medical experience and terminology required.
• Must be computer literate.
• Ability to perform mathematical calculations.
• Above average spelling skills.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patient's needs efficiently. Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.

Galen Medical Group is a member of the TN Drug-Free Workplace and it is a requirement that we conduct a pre-employment drug screen, as part of the hiring process. 

Why should you apply?

• 401(k) benefits.
• Education reimbursement.
• Holiday Pay.
• Great earned time-off policy.
• Company-paid Life Insurance & Long Term Disability.