Revenue Cycle Specialist

About This Role

Ensuring the timely filing of third-party claims and following up promptly is at the heart of the Revenue Cycle Specialist role. This position is ideal for someone with a can-do attitude and a keen eye for detail, who wants to make a real difference in the lives of patients facing serious medical challenges.

Responsibilities

• Follow CMS updates and adhere to billing guidelines dictated by Medicare CMS and insurance carriers for payments and reimbursements.
• Work and manage insurance claims through Revenue Cycle and Denial Management to timeline determined by commercial, managed care, and governmental insurance providers.
• Review insurance claims for effective payment and timely billing turnaround for claim adjudication.
• Provide timely notation of actions and remediation practices taken on patient accounts.
• Submit electronic claims and paper claims according to insurance file order for payment and collection activities across all payor types.
• Re-bill claims with additional ICD-10 codes from medical reports and records as needed.
• Operate effectively across department lines and adhere to the PIISF Team Norms to enable uninterrupted cash flow from payors and patients.
• Process insurance and patient refunds, providing payment solutions and recouping patient out-of-pocket balances across all account types.
• Respond to patient account inquiries and provide billing statements, payment receipts, itemized statements, and billing records as requested.
• Work insurance correspondence, remittance advice, submit appeals, and make adjustments to claims in efforts to receive payments for open balances.
• Engage patient involvement for continued claim issues with insurance carriers as needed for Coordination of Benefits and claim remediation purposes (except Medicare and Medicaid Insurance).
• Notify management of any insurance trends identified.
• Correct authorizations and verification information when necessary.

Requirements

• High school diploma is required; a college degree or working towards one is a plus.
• 3 to 5 years of extensive billing and collections A/R experience is required; experience in a radiology and imaging services setting is preferred.
• Coding experience is a plus.
• Must successfully pass AHCA Level 2 screening.
• Must be approved for EPIC access by MHS.
• Must have flexibility to travel between all PIISF Centers and willingness to work from any one site for extended periods as needed.

Benefits

• Competitive salary, commensurate with experience.
• Bonus eligible within the first full quarter.
• Medical, dental, and vision insurance.