What are the responsibilities and job description for the Home Health Revenue Cycle Specialist position at the Chickasaw Nation?
We are currently looking for a Full Time Home Health Revenue Cycle Specialist to join our Revenue Cycle Group team located at the Chickasaw Nation Medical Center working 8:00AM-5:00PM - Mo Tu We Th Fr.
Summary:
The Home Health Revenue Cycle Specialist will be responsible for prior authorization, accounts receivable, and claim generation functions necessary to ensure maximum support of third-party revenue cycle.
Responsibilities:
- Verifies patient insurance, confirms benefits eligibility, performs authorizations, pre-certification, and/or notification for Home Health
- Documents insurance requirements in patients’ electronic health records
- Resolves claims issues with Medicare, Medicaid, Commercial, and Managed Care
- Researches missing information needed to submit a clean claim
- Traces all claims to payers to ensure that claims are being paid in a timely manner
- Follows-up with insurance carriers on denied/rejected claims to work with carrier for resolution on claim
- Maintains accurate notes in billing system for follow up activity
- Accurately interprets Explanation of Benefits (EOBs) to identify payment discrepancies
- Monitors all reports to ensure that claims are accepted and ensures accurate re-submission of rejected claims
- Reviews suspended or denied claims and makes corrections for resubmission for reimbursement
- Analyzes and maintains a portion of the total billing operation for third party programs and acts as an advocate for the Health System in collection of alternate resources
- Promotes positive teamwork and cooperation within all areas; Billing, Collecting, Posting, Pre-Registration, and Prior-Authorization as they will work closely with each other and are dependent upon each other’s success
- Maintains confidentiality, security, and integrity of data and information
- Provides first class customer service to both internal and external customers and responds to inquiries, compliments, and/or complaints with professionalism, courtesy, and efficiency
- Answers questions in a courteous and professional manner
- Determines needs and seeks positive experiences and outcomes
- Completes all training and development requirements and participates in continuing education opportunities
- Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
- Maintains a clean, organized work area and ensures a safe environment
- Maintains and promotes professionalism
- Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
- Adheres to Chickasaw Nation dress code standards
- Maintains knowledge of and follows all rules, regulations, policies and guidelines for assigned area
- Performs all other duties as assigned
Competencies:
Essential:
Essential:
- Able to follow instructions, both written and oral
- Able to adhere to all scheduling and attendance requirements
- Must be able to exert analytical and critical thinking skill
- Must be detail-oriented
- Must be self-motivated
- Ability to work independently
- Honesty, truthfulness, reliability, accountability
- Able to read, understand, apply, and retain knowledge of Chickasaw Nation, departmental, divisional and all other rules, regulations, policies, procedures and guidelines
- Possess basic knowledge of medical terminology
- Must have working knowledge of insurance authorization and billing processes
- Ability to proofread for spelling, grammar, and formatting errors and make appropriate modifications
- Applied knowledge of medical coding and billing guidelines
- Knowledge of relevant privacy regulations such as The Privacy Act, Freedom of Information Act and Health Insurance Portability and Accountability Act (HIPAA)
- Knowledge of third party payor guidelines
- Knowledge of revenue cycle billing, hospital billing, professional billing, and claims processing operations and workflows
- Must be proficient in the use of electronic health record keeping systems
- Working knowledge of managed care and other health plan eligibility, benefit determination, precertification and referral requirements and processes
- Organizes work and assigned area logically and orderly
- Establishes professional working relationships as appropriate
- Able to verbally communicate in a professional and positive manner with other team members, departments, guests and management
- Writes effective communications with team, departments, guests and management
Skills:
Essential:
Essential:
- Intermediate computer skills
- Intermediate skill using Microsoft Office products
- Excellent Phone Skills
- Accurate typing and/or data entry skills
Experience:
Essential:
Essential:
- 1 year directly related experience
Education:
Essential:
Nonessential:
Essential:
- High School, GED or Equivalent
Nonessential:
- Bachelors Degree in directly related field
Credentials:
Essential:
Essential:
- Pass general background check
- Standard Driver's License
Working Conditions:
Essential:
Essential:
- Works in an office setting
- Sitting up to 100% of shift
- Sometimes lift and or carry up to 10 lbs
- Standing up to 25% of shift
- Walking up to 25% of shift
- Sometimes bend, kneel, stoop, push, reach
- Subject to traveling and working at other locations or in other environments
- Pass pre-employment drug test
Training
- It is the responsibility of each employee to attend required training for their position or profession as determined by their line of support (LOS) or the leadership of the Chickasaw Nation. It is the responsibility of those who supervise, manage or otherwise lead employees or teams to ensure each employee has access to and receives all required training.
Mission, Vision & Core Values
Mission:
Mission:
- To enhance the overall quality of life of the Chickasaw people.
- To be a nation of successful and united people with a strong cultural identity.
- The Chickasaw People
- Cultural Identity
- Servant Leadership
- Selflessness
- Can Do Attitude
- Perseverance
- Stewardship
- Trust and Respect
- Loyalty
- Honesty and Integrity
- Teamwork