About This Role
This role is responsible for reviewing and processing claims at various stages of the revenue cycle in a timely and compliant manner. The specialist ensures the highest possible reimbursement is achieved and that all operational service commitments are met for assigned clients.
Responsibilities
- Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance
- Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff
- Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues
- Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim
- Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion
- Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs
- Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though
- Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved
- Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness
- Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs
- Consistently support and demonstrate the company mission and values
- Perform other duties as assigned
- Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager
- Serve as backup to other team members as required
- Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist or Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager
Requirements
