Revenue Cycle Specialist (Billing & Customer Service)

Description

POSITION TITLE: Revenue Cycle Specialist (Billing & Customer Service)

RESPONSIBLE TO: Revenue Cycle Director

FLSA STATUS: Non-Exempt    

Purpose of Position: The Revenue Cycle Specialist plays a vital role in supporting the financial health of the organization by ensuring accurate and timely billing of insurance claims for medical, dental, and behavioral health services. This position is responsible for resolving and assisting patients with billing inquiries, resolving issues with insurance billing and eligibility and ensuring compliance with FQHC-specific billing regulations. The role requires collaboration across departments and contributes directly to the organization's revenue cycle integrity and patient satisfaction.

Requirements

Qualifications

1. High school diploma or GED equivalent required; Associate degree in accounting or business administration preferred.
2. 3 years’ experience in a medical office with knowledge of medical terminology, billing insurance, insurance payment posting, ICD and CPT coding systems.
3. Knowledge of FQHC billing practices including PPS and wraparound claims preferred.
4. Proficiency in billing software such as Epic a plus.
5. Strong customer service skills and the ability to empathize with patients to resolve issues.
6. Strong attention to detail, time management, and organizational skills.
7. Excellent interpersonal, communication, and problem-solving abilities.
8. Understanding HIPAA, Medicaid/Medicare billing guidelines, and payer-specific regulations.

Responsibilities

1. Act as the primary point of contact between patients, internal teams, providers, and external billing agency.
2. Respond promptly and professionally to customer service inquiries via phone and portal.
3. Research and resolve issues related to payors, insurance claims, and patient accounts.
4. Manage incoming mail and return mail.
5. Assist patients and staff with sliding fee discount program.
6. Post adjustments for prompt pay and other areas per policy.
7. Address registration discrepancies and insurance eligibility concerns.
8. Collaborate with internal staff and external contractor to resolve billing and customer service issues.
9. Utilize Electronic Health Record (EHR) system to update patient information, process billing data, and support provider and staff needs.
10. Maintain accurate documentation of all interactions and resolutions in compliance with organizational policies.
11. Support continuous improvement initiatives to enhance patient experience and billing efficiency.
12. Collaborate with front office, clinical staff and finance team to resolve billing discrepancies.
13. Assist with payment posting responsibilities as needed.
14. Respond to patient inquiries via phone and electronic messages regarding billing and insurance.
15. Always maintain patient confidentiality.
16. Meet productivity standards and contribute to quality measures related to VFHC initiatives.
17. Uphold the Mission, Vision, and Values of Valley Family Health Care.
18. Other duties as assigned.

Work Environment

This role is primarily on-site with potential for hybrid work arrangements based on performance and departmental needs. Standard office hours apply, with occasional flexibility required to meet deadlines.

Performance Metrics

1. Average response time
2. Workload management
3. Patient satisfaction with billing inquiries

Physical Requirements:

1. Must be able to lift 25 lbs.
2. Continuous sitting, standing, and walking.
3. Correctable vision and hearing.
4. The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.
5. The ideal candidate must be able to complete all physical requirements of the job with or without reasonable accommodation.