Revenue Cycle Coordinator

La Clínica del Pueblo Job Description

Job Title: Revenue Cycle Coordinator

Department: Finance

Supervisor: Patient Revenue Manager

Location: Hyattsville, MD

Classification: Salary/Exempt

Synopsis: Under the supervision of the Patient Revenue Manager, the Revenue Cycle Coordinator is responsible for preparing and submitting timely and accurate insurance claims to third-party payers using eClinicalWorks (eCW), verifying and posting payments and adjustments, managing aging reports, and following up on denied or underpaid claims. The Revenue Cycle Coordinator also plays a critical role in assisting with payer enrollments for all providers, ensuring credentialing documentation is complete and submitted in a timely manner, and maintaining compliance with FQHC and payer-specific requirements. This role requires a high level of attention to detail, the ability to work independently, and in coordination with La Clínica’s staff and contractors.

Qualifications: Required Education and Experience:

• High school diploma or equivalent required.
• Understanding of payer EOBs/Remits.
• Strong computer skills including Microsoft Word, Excel
• Minimum of 2-3 years of experience using ICD-10, HCPCs, CPT, medical coding and billing.
• Minimum of 2-3 years of experience in a revenue cycle billing position (Experience with medical billing, patient registration, or insurance verification).
• Experience using electronic medical records (EMR); eCW preferred.
• Excellent oral, written, and telephone communication.
• Working knowledge of rules and regulations pertaining to the FQHC guidelines.
• Ability to prioritize and manage multiple tasks with efficiency in dealing with multiple facilities, departments and programs.
• Ability to handle a large volume of project receiving, submitting and researching claims.
• Ability to work independently with minimum supervision in a team-oriented environment and interrelates well with individuals with diverse ethnic and cultural backgrounds and needs.

Preferred Education and Experience

• eCW experience preferred.
• Registration/intake experience preferred.
• Payer enrollment experience preferred.
• Knowledge of medical terminology and practices

Duties and Responsibilities:

• Prepares and submits clean claims to various insurance companies either electronically or paper.
• Reviews and posts denials to accounts according to the EOB to ensure accurate payment status and account activity.
• Reviews and assigns claims that need provider attention via jellybeans in eCW to appropriate staff.
• Prepares bank reconciliation log daily to report incoming insurance checks/deposits
• Monitors aging reports and takes necessary actions to guarantee payments of claims.
• Reviews accounts daily and makes phone calls or checks insurance portals to assigned insurance groups for insurance follow-up to determine claim adjudication.
• Assures compliance with applicable billing laws and regulations to maximize cash receipts.
• Contacts insurance carriers regarding non-payments and/or improper payment on claims.
• Identifies problem accounts with payers; investigates and correct errors
• Follows-up on missing account information and resolves past-due accounts.
• Prepares reports to identify and resolve accounts receivable.
• Helps with year-end reports such as patient revenue reports, adjustments, aging report, charity care, etc
• Posts patient payments to accounts and applies payment to claims.
• Posts ERA payments, adjustments, and write offs to appropriate accounts.
• Prepares, reviews, and sends patient statements.
• Reviews Telephone Encounters assigned for patient account follow up.
• Answers inquires by phone regarding past-due accounts and insurance guidelines.
• Transfers bills to secondary or tertiary accounts, if applicable.
• Makes adjustment to either patient or practice accounts based on internal reports and/or documentation.
• Responsible for reading and understanding various types of Explanation of Benefits.
• Keeps supervisor informed of areas of concern and problems identified.
• Assists in the preparation of monthly reports to ensure accuracy and timely processing of claims billed through the EMR.
• Prepares and distributes monthly Unlocked Encounters Report to ensure all visits are locked and ready to bill for the month.
• Assists with preparing and submitting provider enrollment and revalidation applications to commercial and government payers (e.g., Medicare, Medicaid, MCOs).
  
• Assists with enrollment application status and follow up with payers to ensure timely processing.
• Assists with maintaining accurate and current enrollment records, rosters, and CAQH profiles.
• Assists with updating and maintaining provider and organizational information in payer portals and directories.
• Maintains strict confidentiality regarding confidential conversations, documents, and files.
• Participates in educational activities and attends monthly staff meetings.
• Adheres to all HIPAA guidelines/regulations
• Perform other related duties as assigned

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times

Supervisory Responsibilities: None