Revenue Cycle Specialist

Description/Job Summary

The Revenue Cycle Specialist is fully remote postition responsible for billing, collections, claims resolution and payment posting for multiple government, commercial, and private payers for programs assigned. The Revenue Cycle Specialist will communicate any processing issues to the Manager and/or additional support team member as directed.

Resources for Human Development is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, veteran, or disability status.

Responsibilities/Duties

Charge and Claim Processing

• Confirm that all services provided have been entered.
• Provide feedback to program staff regarding incomplete and/or incorrect services and maintain reconciliation of returned services to ensure correction and timely billing
• Appropriately process all services to be billed.
• Timely file all claims -primary and secondary.
• Confirm successful transmission to payers and timely resolve any transmission errors.
• Timely communicate un-billable claims to mitigate timely filing denials.

Claim Resolution

• Follow-up with payers to resolve all rejections, denials, re-submissions, and appeals.
• Communicate with insurance companies, program staff and other internal stakeholders to settle billing issues and resolve open claims.
• Work open claims systematically giving priority to aged claims to resolve balances in a timely manner.
• Respond to inquiries or follow up on issues and provide information to resolve outstanding balances.
• Partner with program personal, ensure compliance with RHD Billing requirements and guidelines.
• Create and provide reports to analyze billing and accounts receivable.
• Initiate the write-off of claims, where applicable

Payment posting

• Ensure payments and adjustments are properly applied and that payments reconcile to the EOB's received by payers.
• Retrieve payment files from various websites for payment processing.
• Process payments received from multiple insurance plans, third parties and patients.
• Ensure deductibles, coinsurance, copay and denials are properly posted.
• Perform payment research and investigation as needed.
• Reconciling Unapplied Accounts

EHR Support

• Provide support and input to manager and/or EHR team in initiating and requesting changes to program technical updates
• Provide support and input to manager and/or EHR team regarding implementation of new or additional programs in EHR system

Other

• Other duties as assigned
• Commitment to RHD organizational values and program & corporate should be demonstrated as job duties are performed

Required Experience

• Associate Degree in a business, healthcare administration, accounting or related field with 3 years of experience or a High School Diploma with 5 years experience
• Prior work experience with billing, claims follow-up, and payment posting for healthcare or mental health in a high-volume Medical Insurance Billing setting

Required Education

• Associate Degree in a business, healthcare administration, accounting or related field with 3 years of experience.
• or
• High School Diploma with 5 years' experience

Required Qualifications

• Proficiency in Microsoft Excel and Outlook
• Must be detail-oriented and able to juggle multiple assignments.
• Experience with Netsmart Avatar application is a plus.

Program Summary

Resources for Human Development is a national human services non-profit founded in 1970, specializing in creating innovative, quality services that support people of all abilities and challenges wherever the need exists. We support more than 160 programs across 14 states, serving tens of thousands of people of all abilities every year. RHD maintains a corporate office in Philadelphia, which provides fiscal supervision, management oversight, support and encouragement, and technical assistance to its programs. RHD prides itself on its history of innovation, not only in the services we offer but also in our management approach rooted in RHD's Values. RHD is committed to the fundamental value of dignity and respect for all human beings, to the empowerment of our consumers and staff, and to the flexibility to meet the changing needs of all our partners and those we serve.

"RHD employees and programs in the City of Philadelphia are required to follow the COVID vaccine mandate. The City of Philadelphia has issued an Emergency Regulation Governing the Control and Prevention of COVID-19 Mandating Vaccines for Healthcare Workers and In Higher Education, Healthcare, and Related Settings ("Vaccine Mandate Regulation"), which mandates vaccine for healthcare workers and in higher education, healthcare, and related settings. This mandate became Effective on August 16, 2021 and requires Healthcare Workers and certain workers at Healthcare Institutions to be fully vaccinated by October 15, 2021. Fully vaccinated means it has been two weeks since the final dose of vaccine. The regulation does allow individuals to apply to RHD for an exemption based on a sincerely held religious belief that would prohibit vaccination for COVID-19 or because of medical conditions that preclude administration of one of the available vaccines."