Revenue Cycle Specialist

This is an In Office Position M-F 8am to 5pm

Direct Responsibilities
• Adheres to affiliate goals and policies on professionalism and provides excellent internal and external customer service.
• Participates in the affiliate’s efforts to achieve revenue cycle goals
• Reviews and makes corrections to rejected claims for invalid CPT, DX, missing modifiers, COB, and any other required interventions and resubmits corrected claims.
• Performs daily/monthly audit of self-pay encounters to ensure integrity of patient accounts and sends emails to health centers, as appropriate.
• Ensures timely follow-up of open accounts receivable for assigned accounts in accordance with the affiliate’s established revenue cycle procedures and goals.
• Reviews Electronic Remittance Advices and Paper Explanation of Benefits upon receipt to confirm that payment was made as expected and to immediately identify the need for follow-up with the payer or to process a credit adjustment/refund request.
• Reviews credit balances of assigned accounts and makes appropriate adjustments, transfers or refund requests and documents actions in EPIC/NextGen. Uses the Credit balance report in accordance with the affiliate’s established revenue cycle procedures and processes refunds for accounting team to issue.
• Manages any returned checks. Works closely with accounting team to make appropriate adjustments to accounts whose checks were returned.
• Works with the revenue cycle team to identify revenue generation and reimbursement opportunities.
• Works closely with clinics and front office staff to take action on any trends identified that involve operations workflows.
• Trains clinic staff on billing and collections processes within EMR system. Trains new collections processes or changes in workflows
• Provides financial counseling to patients and clinic staff to assist with patient care.
• Runs reports and reviews accuracy and status of patients receiving justice funds. Uploads JF reports monthly.
• Manages JIRA tickets affiliated with revenue cycle, ensuring they are submitted timely, include pertinent information and are followed up on.
• Shares and provides feedback on build/workflow configuration and requests changes for EMR configuration.
• Works affiliate work queues and communicates to manager and Better Health any work queue functionality issues.
• Maintains confidentiality of all department, patient and billing matters and adheres to all HIPAA guidelines/regulations.
• Completes other special projects and department deliverables as assigned by members of the senior leadership team.
• Works with all departments in a positive, supportive, and collaborative team manner.
• Actively participates in the Accreditation process to ensure compliance with Elements of Performance (EOP), medical standards and guidelines (MS&G) and all other state and federal regulations.
• Participates in supporting grants and donations to fund services and projects at the affiliate, through work like, but not limited to program narratives, budgets, data queries, analysis, and participation in interviews with grantees and meetings with donors.
• Actively participates in training, orientating and cross training co-workers, managers and staff on processes and procedures in compliance with PPAZ standards and guidelines.

Other Requirements
• Outstanding moral character and commitment to neutrality, confidentiality, and professionalism
• Ability to build trust and relationships with broad audiences
• Exceptional organization skills and attention to detail
• Excellent written and verbal communication skills with emphasis on tact and diplomacy
• Ability to identify and solve complex problems using good judgment and discernment
• Ability to work independently in a fast-paced growth environment, manage multiple priorities and translate business strategies into actionable plans
• Proven project management skills and track record of delivering results on time
• Demonstrated analytical skills and the ability to interpret data, identify trends and recommend solutions
• Demonstrated computer skills with proficiency in HRIS, MS Outlook, Word, Excel, and PowerPoint

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience
• A High School diploma or General Education Degree (GED), required.
• At least one years of revenue cycle experience in a hospital or medical practice setting is required.
• Previous experience using ICD-10 Medical Coding, Current Procedural Terminology (CPT) and HCPCs is required. Formal coding training is desirable.
• Solid foundation in medical terminology is required.
• One years’ experience in performing insurance verification via payer portals and phone calls to insurance companies with the ability to accurately calculate patient responsibilities that should be collected at the time of service.
• Previous experience using Epic EMR software experience is required, including ability to create reports and manipulate data, including excel exports capabilities.
• Ability to navigate and understand documentation in Epic EMR is required.
• Solid understanding of insurance company explanation of benefits is required.
• Basic Excel, MS Word with Windows based computer experience skills required.
• Good telephone and written communication skills are required.
• Works with Better Health to ensure patients’ insurance coverage is verified.

LANGUAGE SKILLS
Ability to read and write simple instructions, short correspondence, and memos. Ability to communicate clear instructions to enact policy decisions. Ability to effectively present information in one-on-one and small group situations with employees of the organization.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage and to draw and interpret bar graphs. Ability to read, manipulate and develop fiscal data on tables.
REASONING ABILITY
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

CERTIFICATES, LICENSES, REGISTRATIONS
None required.

Salary : $24 - $27