Revenue Cycle Specialist

Department:  Revenue Cycle                                              Job Status:  Full-time                     

FLSA Status:  Non-Exempt                                                   Reports to:  Revenue Cycle Manager

Positions Supervised: None                                                Amount of Travel Required:  Less than 5%.

Work Schedule:  Monday-Friday, 8am-5pm

Position Summary

Position will maintain aspects of Medicaid, commercial insurance, and self-pay accounts as assigned by Revenue Cycle Manager.  Stays current with the billing regulations and information for each payor.  Position will cross-train with other members of the Revenue Cycle Team.

Essential Functions

Position is responsible for all aspects of working of Medicaid, commercial insurance, and self-pay accounts as assigned by Revenue Cycle Manager.

• Monitor daily alerts.
• Review and work daily alerts pertaining to Medicaid, commercial insurance, and Waiver accounts.
• Review payor set-up for completed intakes.
• Run daily reports for authorizations ready to expire or authorizations running low on units and contact the appropriate staff that an authorization is expiring and an Outpatient Treatment Request (OTR) is needed.
• Follow up with clinician and fax the Outpatient Treatment Requests and other appropriate documents to appropriate payor.
• Update the authorization module based on approval letters.
• Follow up with staff and specific payor on all outstanding precertification requests.
• Perform daily posting of payments via electronic means whenever applicable.  Ensure that payments are in balance. 
• Work denials on remittance advices if necessary daily by running applicable reports from Credible to review.  Denials may be kept track of on a spreadsheet that is viewable by entire department.  The spreadsheet will be maintained as claims process.
• Document in chart all notes to keep staff informed of what has transpired to date.
• Stay abreast of changes in our system and report any problems to the Revenue Cycle Manager.
• Keep knowledgeable and up-to-date with policy changes and alert appropriate staff.
• Review Medicaid, commercial insurance, and Waiver bulletins and communicate applicable changes to appropriate staff.
• Maintain self-pay accounts, reflecting payments, bankruptcies, or set-off accounts, as applicable.
• Notify Revenue Cycle Manager in a timely manner any time off to insure job duties are covered.
• Cross train on all department positions to serve as back-up coverage when needed.
• Maintain and assist with paperwork required for the TAY (transition aged youth) program, as assigned by Revenue Cycle Manager.
• Assist with timely and complete filing of Transportation reports, as needed.
• All other duties as necessary and/or assigned.

Education/Licensure:

• High school diploma or GED equivalent.
• A valid driver's license, a good driving record, current auto insurance and reliable transportation maybe required.
• Must successfully pass the KBI, DCF, and all other background investigations.

Experience:

• 1 year experience in health care billing preferred.
• Working knowledge of Microsoft Office Suite, with strong proficiency in Excel and Word.

Knowledge/Skills/Abilities:

• Effective communication skills (verbal and written)
• Customer focused (internal and external)
• Excellent listening skills
• Leadership
• Accountability
• Reliability
• Trust/Integrity
• Adaptability/Flexibility
• Time Management
• Organizational Skills
• Proficiency in MS Office Suite with ability to learn other software programs as necessary
• Relationship building
• Problem Solving
• Attention to detail and accuracy in work
• Being collaborative
• Open to learning and accepting feedback
• Ability to maintain appropriate boundaries and confidentiality
• Strengths based
• Culturally respectful

Physical Demands

N (Not Applicable)                                  Activity is not applicable to this position.

O (Occasionally)                                     Position requires this activity up to 33% of the time (0 – 2.5+ hrs. /day)

F (Frequently)                                         Position requires this activity from 33% - 66% of the time (2.5 – 5.5+ hrs. /day)

C (Constantly)                                         Position requires this activity more than 66% of the time (5.5+ hrs. /day)

Physical Demands                                                                           Lift/Carry

Stand (N)                                                                                            10 lbs. or less

Walk (O)                                                                                               11 – 20 lbs.

Sit (C)                                                                                                     21 – 50 lbs.

Manually Manipulate (N)                                                                   51–100 lbs.

Reach Outward (O)                                                                           Over 100 lbs.

Reach Above Shoulder (O)

Climb (N)                                                                                                   Push/Pull
Crawl (N)                                                                                                 12 lbs. or less
Squat or Kneel (N)                                                                                  26- 40 lbs.
Bend (O)                                                                                                   41-100 lbs.