HFMG Revenue Cycle Specialist - Patient Business Services

Job Description

POSITION SUMMARY

The Revenue Cycle Specialist will be responsible for the review, analyzation, trending, follow-up and resolution of third-party claims reimbursements to include the identification, billing and collection of payments. The Revenue Cycle Specialist will actively engage with other departments to ensure timely resolution of all outstanding accounts to ensure maximum reimbursement.

PRIMARY ACCOUNTABILITES

• Knowledge of third-party claims reimbursement practices.
• Advanced knowledge of payer contracts, payment policies, regulations to ensure correct payment of claims.
• Thorough knowledge of complex insurance correspondences to include explanation of benefits, remittance advices and denial letters.
• Advanced understanding and ability to navigate payer websites and vendor applicable systems to verify insurance benefits, understanding insurance payments, denials and correspondences.
• Maintain established quality assurance and productivity benchmarks while utilizing best practice standards established.
• Process all referrals in a timeframe established by the department.
• Accurately update accounts in all systems to reflect work being performed.
• Ability to retain information provided and apply logic and critical thinking to identify payer trends resulting in payment delays
• Communicate identified payment trends to leadership promptly and accurately and provide solutions to resolve challenges and issues.
• Assist with training and mentoring of new hires. Ensure compliance with state and federal laws regarding all aspects of role.

Qualifications:

MINIMUM QUALIFICATIONS

• Education:
  • High School Diploma or GED.
• Work Experience:
  • One year experience in Healthcare Billing and/or AR follow up or related field.
• Work Experience in lieu of degree:
  • None.
• Licensure:
  • None Required.
• Certification:
  • None Required.
• Skills/Knowledge/Abilities:
  • Microsoft Office - Outlook, Word, Excel, PowerPoint.

PREFERRED QUALIFICATIONS

• Work Experience:
  • Two (2) year progressive experience in Healthcare Billing and/or AR follow up or related field.
• Skills/Knowledge/Abilities:
  • Critical thinking, Decision-making skills.

PHYSICAL REQUIREMENTS Sedentary

• Majority of time involves sitting or standing; occasional walking, bending, stooping.
• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined; on site or remote.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.