REVENUE CYCLE SPECIALIST I

Job Summary: This position is part of a growing billing department that is responsible for all Ambulatory Surgery Centers and Clinic’s billing functions. This includes processing all insurance payments and auditing accounts for accurate payments and adjustments are being made and monitoring to ensure insurance is paying according to contract. Must be organized and efficient in following all protocols and procedures in the department to provide a dazzling experience for our patients.

Essential Functions:

· Identifies, research, and ensure timely processing for payments and error corrections, ensuring appropriate documentation of payments, allowances, denial, rejections, are recorded on individual accounts.

· Extensive familiarity with reimbursement policy(s) for in and out of network benefits levels, applicable deductible, and co-insurance benefits.

· Efficiently use multiple systems and insurance payer websites/portals.

· Communicate with leadership regarding payment or denial issues based on credentialing or fee schedule contracts.

· Train other clinic staff on best practices when problems arise.

· Ability to audit patient account ledger to ensure accurate balances and payments have been applied appropriately.

· Ability to work remotely if needed.

· Knowledge of Management Care products such as HMO, PPO, and POS.

· Assurance of daily posting of all payments and adjustments.

· Perform quality reviews of patient accounts to ensure proper posting of insurance payments, recoupments and refunds.

· Detailed knowledge of revenue cycle functions and metrics.

· Work closely with all departments to achieve goals.

· Other duties as assigned

Education

Required:

· High School diploma or equivalent.

· Medical billing and coding certification.

Experience/Skills/Other Requirements

Required:

· Ability to work in a professional, positive, and pleasant way with other Team members.

· Typing ability of 50 wpm.

· Communicate clearly and effectively with patients and Team members.

· React calmly and effectively in stressful situations.

Desired:

· Progressive medical billing experience

· ICD-10: 4 Years

· Detailed knowledge of revenue cycle functions and metrics

· Must be able to effectively communicate with patients about their accounts

· Experience in larger practices with multiple locations and specialties

Physical/Mental Demands:

· Regularly stand, walk, and sit.

· Occasional stress from workload or from dealing with upset patients or emergency situations.

· Normal vision and hearing are needed.

· Must be able to lift to 25 pounds.