Revenue Cycle Specialist

About This Role

The Revenue Cycle Specialist works closely with the patient billing team to maximize reimbursement from insurance carriers, patients, and other entities. This role requires a high level of attention to detail and the ability to work well in a fast-paced team, developing strong knowledge in insurance carrier policies, clearinghouse edits, and clinical requirements to expedite cash flow. The specialist will follow up on claims not paid, underpaid, or denied, identify root cause denial trends, and prepare appropriate appeals.

Responsibilities

• Research patient questions about accounts, adjust patient accounts, and respond to written correspondence from patients
• Perform patient account collections and billing tasks, including maintaining patient account records
• Keep patient account balances up to date and correspond with insurers, following up on unpaid bills
• Verify and/or correct billing matters, research and reconcile credit balances, and ensure efficient processing of denials and appeals
• Facilitate resolution to any claims problems and follow up on balances due from insurance companies
• Provide patient account billing information to patients, insurers, hospital billers, doctor’s office representatives, etc., in accordance with organizational policies and procedures

Requirements

• Associate degree in business or a related field preferred
• 3-5 years of recent experience in a healthcare setting working directly within the revenue cycle process, preferably as a revenue cycle specialist
• Knowledge and understanding of payor portals, denials, appeals, payer contract verbiage, and interpreting explanation of benefits (EOB)
• Must understand revenue codes, diagnosis codes, be CPT/HCPCS certified, and have institutional billing knowledge
• Experience with Microsoft Suite, Time, DocuWare, and Clarity
• Experience with resolving credit balances/payer refunds desired
• Skill sets to include 10-key by touch, typing a minimum of 25 words per minute (WPM), and general skills in word processing and spreadsheet applications
• Ability to prioritize work activities with minimal supervision, in an individual and team setting environment
• Strong written and verbal communication, analytical thinking, attention to detail, and problem-solving skills
• Easily adapts to change
• Ability to learn and utilize various software applications and information systems to perform work responsibilities

Benefits

• Choice of 3 medical insurance plans through Kaiser Permanente (PPO, HMO & HDHP)
• Delta Dental
• Vision Services Plan
• 401 Retirement match and discretionary match
• Disability benefits such as Short-term & Long-term Plans