Revenue Cycle Specialist

About This Role

This role involves overseeing the entire revenue cycle, from processing bills and managing denials to generating reports that track performance. The Revenue Cycle Specialist will work under the Billing Manager, interacting with third-party payers, vendors, and staff to resolve claims, identify underpayments and trends, and ensure the organization's financial health.

Responsibilities

• Process billing by receiving, interpreting, processing, and submitting claims through various edits to third-party payers, both electronically and in hard copy format
• Conduct billing follow-up by contacting third-party payers or accessing payer websites/provider portals to determine payment expectations and resolve claim issues
• Facilitate information communications and processing by interpreting and processing third-party payer and patient inquiries accurately and timely to expedite payment
• Manage denial receivables to resolve accounts
• Develop strategy for appeal, appeal follow-up, and/or reprocessing accounts
• Analyze denials to determine the reason they occurred
• Identify trends and report significant and recurring issues along with possible solutions to the Denials Management Supervisor and Billing Manager
• Take corrective action through systematic and procedural development to reduce or eliminate payment issues
• Maintain familiarity with payer methodologies and communicate effectively with NMHS staff
• Manage paid claims to resolve underpaid accounts
• Develop strategy for appeal, appeal follow-up, and/or reprocessing accounts
• Analyze underpayments to determine the reason they occurred
• Identify trends and report significant and recurring issues along with possible solutions to the Denials and Underpayment manager
• Professionally and effectively communicate with third-party carriers, vendors, and hospital contacts to promote contractual compliance
• Contact insurance companies regarding denial, underpayment, or rejection issues
• Serve as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues
• Assist in preparation of monthly denial reports and other denial reports as requested
• Assist in preparation of monthly variance reports and other variance reports as requested
• Adhere to NMHS/NMMC Policies/Procedures/Guidelines
• Comply with applicable Local/State/Federal policies/procedures/guidelines/regulations/laws/statutes

Requirements

• Bachelor's Degree in Business, coding, or equivalent field
• Willing to consider an Associate's Degree with 4 years of Claims, Billing/Follow-Up, or revenue cycle experience beyond the minimum requirement in lieu of a Bachelor's degree