Healthcare Revenue Cycle Specialist, Business Office, Downtown Nashville

SUMMARY: The Healthcare Revenue Cycle Specialist demonstrate thorough knowledge of the claims revenue cycle. The Healthcare Revenue Cycle Specialist position is responsible for answering patient and staff inquiries, reviewing outstanding and/or denied insurance claims, submitting insurance appeals, and maintaining assigned insurance queues.

The Healthcare Revenue Cycle Specialist must have the ability to provide excellent Customer Service to patients and staff and correctly answer a question regarding insurance and balances. The type of questions may include, but are not limited to insurance participation, correct coding guidelines, carrier specific medical policies, and denial codes, review of accounts for payment application, as well as the ability to assist patient and/or staff in understanding insurance benefits and how the benefits were applied to the service(s) received at HMA.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: (Other duties maybe assigned.)

• Work denied claims through the practice management queue
• Processing of denials in a timely and accurate manner
• Correct and any denied claim, including submitting additional information or documentation as requested
• Creation and submission of appeals
• Communicate with insurance companies, as needed
• Query provider in a timely manner, as needed
• Interpret and apply compliance guidelines to maintain billing integrity
• Update and maintain patient account information and have the ability to make adjustments as necessary, and according to company policy
• Receive, sort and work incoming correspondence daily
• Identify and communicate trends in denials to management
• Answer patient questions, inquiries and concerns regarding their accounts; verify balances and refunds for accuracy, and ensure timely follow up with patient, as needed.
• Audit accounts referred by Patient Service Representatives and Patient Accounts, as well as provide a response in a timely manner
• Utilize the Insurance Analyst work queues to follow up on accounts until the account has been satisfactorily resolved.
• Post corrected claims and any payments associated with that correction
• Transfer credits in an account
• Follow HMA guidelines in applying self-pay discounts, charity and per request adjustments.

SUPERVISORY RESPONSIBILITIES:

None

QUALIFICATIONS:

• Strong Customer Service Skills
• Excellent telephone etiquette and skills
• Exceptional written and verbal communication skills
• Ability to work with little supervision
• Superior organizational skills
• Self motivated
• Ability to work in a cooperative manner with others
• Regular and predictable attendance

EDUCATION and/or EXPERIENCE:

• High school diploma
• 3-5 years of third-party billing in a physicians office
• Knowledge of ICD-10/CPT Coding
• Experience in medical billing systems
• Must have thorough understanding of Medicare/Medicaid laws, managed care, and commercial health insurance

PHYSICAL DEMANDS:

• Must be able to walk to patient in physicians office and/or sit for 8 to 10 hours a day
• Requires regular walking, bending, pushing, pulling, twisting and lifting
• Must be able to lift at least 10-15lbs
• Ability to delineate between numeric numbers

WORK ENVIRONMENT:

• Office environment-limited exposure to communicable diseases.
• No exposure to blood-borne pathogens or contaminated body fluids
• Fast paced environment