Revenue Specialist

Under leadership from department management, incumbent is responsible for the entire cash receipt cycle of Hometown Health’s revenue for all commercial insurance and Medicare product lines of business including but not limited to Individual and family plans, Medicare Advantage, Medicare Supplement, small and large group clients. In addition, the Revenue Specialist performs complex reconciliation, auditing and system improvement processes. This position works with clients in response to financial issues, determine the source of problems and monitors systems to ensure accurate record keeping to operate within the time pressure of deadlines and respond to clients in a timely and effective manner.

The position responsibilities include:

• Strict adherence to all Federal and State regulations and our State of Nevada department of insurance guidelines.

• Strict adherence to eligibility and enrollment criteria governed by the Centers for Medicare & Medicaid Services (CMS) Medicare Managed Care Manual. Ensuring that all premiums are accounted for and reconciled for new and existing members/group against our billing procedures.

• Ensuring all invoices are generated reconciled and performs collection on outstanding balances.

• Working closely with group administrators/contacts/member to ensure that payment transactions are completed timely to avoid termination and disruption of benefit plans.

• The incumbent must have a thorough understanding of CMS payment factors and an ability to follow updates and changes in Medicare’s reconciliation process to ensure all premiums due are collected. Differences in revenue as a result of this reconciliation are tracked and reported to Medicare. The incumbent must follow-up on outstanding receivables to ensure receipt.

• The Specialist will coordinate reconciliation functions with outside vendors and internal IR staff. The Specialist must keep abreast of CMS changes related to changes in file structure, payment methodology, reporting requirements, and other policy changes impacting the functions of the position.

• The Specialist will work as a liaison between the member and CMS’s Regional Office Representative on retroactive member payment adjustments as needed. Furthermore, the Specialist will reconcile all changes in payments that occur because of these adjustments.

• The Specialist must maintain and stay organized with the following reports for both CMS compliance purposes and SCP operations: reconciliation reports, transaction reply reports (TRR), monthly membership reports (MMR) Accretion Deletion Status Reports, Risk Adjustment (RAPS) Response files, Prescription Drug Event (PDE) files, Coordination of Benefits (COB) reporting, Institutional Reports, working aged transaction status reports (WASR), hospice reports, monthly comparison reports, EFT posting reports and CMS and CMS contracted vendor (Acumen) exception reports. In general, demonstrates the ability to manage workload independently as well as part of a team.

• Demonstrating the ability to work on multiple and more complex tasks with high quality results and adherence to deadlines.

• Demonstrate the ability to manage workload independently, as well as part of a team.

• Assists in training new Revenue Team members on Revenue systems, processes and functions.

• Maintaining regular communication with Leadership, Revenue Senior, Configuration Analyst and customers.

• Demonstrating excellent interpersonal, organizational and communication skills.

• Following procedural lists to develop, compile and process amounts owed to Hometown Health.

• Responsible for ensuring accurate data is sent for the multiple premium audits performed throughout the year.

• Ensuring timely delivery of preparing invoices and recording transactions using Hometown Health’s managed care information system.

• Performing critical thinking and analysis in determining the appropriate group benefit package and riders to assign to members.

• Detailed, accurate and timely membership entry.

• Composing and editing correspondence to internal and external customers.

• Maintaining highly developed reconciliation skills with an emphasis on problem solving.

• Performing complex reconciliation of payments received with billed amounts.

• Analyzing discrepancies in premium reconciliation to maintain compliance with policies, procedures and the guidelines under State and Federal insurance and CMS regulations.

• Solicits payments on overdue accounts.

• Maintains accurate records and files in electronic systems.

• Compiling audit-related and miscellaneous documents regarding billing and collection.

• Preparing late notices to employer groups and notification to internal departments.

• Updates processes pertaining to Revenue.

• Maintaining great customer service skills.

• Discussing confidential information in a professional manner that is in compliance with HIPPA regulations.

• Preparing Schedule A (5500) tax information related to premium for Employer/Brokers annually.

• Prepares MA 1099’s annually to our members.

• Performing other revenue-related duties as assigned

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelor’s Degree or equivalent experience.

Experience:

Three years of business office experience required. Experience in an insurance or financial setting preferred. Experience in managed care, billing and/or collections preferred.

License(s):

None

Certification(s):

None

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, Excel and Word. Must have the ability to use the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Also requires in depth expertise in Excel including but not limited to formulas and advanced capabilities. Typing 45 WPM adjusted for errors.