Job Type:
RegularScheduled Hours:
40Job Summary:
Reports to Revenue Cycle Manager and/or Administrator of RevenueCycle Services, the Revenue Cycle Specialist is primarily responsible for receiving and responding to patients phone calls within one (1) business day, working A/R reports and Explanations of Benefits from insurance companies. They are responsible for working correspondence, refiling unpaid or incorrectly paid claims, and accurately updating or correcting patient demographic or profile information. They are responsible for the filing of claims to all insurance companies, analyzing and responding to refund requests as indicated by the insurance companies, and the entry and editing of all charges.
Job Description:
Job Title: Revenue Cycle Specialist I (MAILROOM)
Non-Exempt
PRIMARY PURPOSE:
The Revenue Cycle Specialist is primarily responsible for receiving and responding to patients phone calls within one (1) business day, working A/R reports and Explanations of Benefits from insurance companies. They are responsible for working correspondence, refiling unpaid or incorrectly paid claims, and accurately updating or correcting patient demographic or profile information. They are responsible for the filing of claims to all insurance companies, analyzing and responding to refund requests as indicated by the insurance companies, and the entry and editing of all charges. The Revenue Cycle Specialist is a highly visible position that is always responsible for creating a positive impression with patients, physicians and other visitors he/she encounters, both in person and on the phone.
BENEFITS:
- Hybrid position-In person with the possibility of remote work) Must live within 1 hr. from Erlanger, Kentucky to be considered) Equipment Provided.
- Paid Time Off
- Medical, Dental, and Vision
- 403b with Match
- Opportunity for Growth
DUTIES AND RESPONSIBILITIES:
- Provide information and resolve issues from patients/family members and insurance companies.
- Work Adjustment, Zero Pay, and A/R aging report and correspondence daily.
- Follow-up with the insurance company as needed regarding payment/non-payment of claims.
- Refile claims to secondary insurance when claims have not been received or processed.
- Submit activity log, audit journals, EOBs, and Account Follow-Up Logs daily.
- Communicate in an effective and professional manner with payors, patients/family members, physicians, support employees, co-workers, and management.
- Answer incoming calls in a professional and courteous manner within 3 rings. Return all voicemail messages within one (1) business day.
- Update patient demographic and profile information provided by patient, office, or insurance company.
- Enter Financial Hardship information and apply the appropriate and correct adjustments to Practice Management system. Make corresponding adjustments to the patients account.
- Responsible for NSF postings, letters, follow-up, tracking of checks and making necessary adjustments to patient's account.
- File claims to various insurance companies.
- Edit and entry of all claims including office, hospital, nursing home.
- Payment posting of patient payments, medical records and Disability payments.
- Adhere to company and system processes, post payments to appropriate accounts, with accurate documentation and balancing.
- Respond to refund requests from insurance companies in a timely manner.
- Analyze overpayments as marked by payment posters to determine if a refund is due.
- Keep an accurate log of refunds for month-end reporting.
- Audit statements and make appropriate corrections. Process weekly reports.
- Responsible for sending out and tracking patient statements and collection letters.
- Set up payment plans or payment arrangements.
- Work all correspondence/C15/C11 reports.
- Refer accounts to collection agencies.
- Post agency payments - verify commissions.
- Perform claims follow-up.
- Responsible for sending medical records requests to offices and noting the accounts.
- Responsible for coordinating the pulling, copying and mailing of EOBs for primary and secondary claim refiles.
- Responsible for logging bad addresses and sending notification to the offices.
- Responsible for Working Claim Edit (Reg) WQ
- Responsible for Working Errors in Quadax
- Keeping Track of Envelopes
- Other Duties as Assigned
OTHER REQUIRED SKILLS AND KNOWLEDGE:
- Knowledge of medical insurance, managed care plans, CPT, ICD9 and ICD10 codes.
- Ability to read and understand Explanations of Benefits from all insurance companies.
- Knowledge of FDCPA and Bankruptcy.
- Detailed and thorough work on special projects as assigned.
EDUCATION:
Minimum: High School Diploma/G.E.D.
Knowledge of Microsoft Excel, Word, Outlook and PowerPoint and the ability to learn other computer skills.
YEARS OF EXPERIENCE:
1 to 3 years of experience in a medical practice, customer service or revenue cycle department.
LICENSES AND CERTIFICATIONS:
CPC required for designated trainer positions as well as those involved in coding directly from the chart.
Preferred: CPC
FLSA Status:
Non-ExemptRight Career. Right Here. If you have a passion for taking care of the community and are interested in Healthcare, you will take pride in the level of care we provide at St. Elizabeth. We take care of patients and each other.
