Revenue Cycle Specialist I- Hfmg Patient Business Services, Full Time

POSITION SUMMARY: To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by: ensuring the financial integrity of Health First, Inc/HF Medical Management by preforming established financial processes that enable and expedite the billing and collections. This includes: Customer Service, billing claims according to Federal/State and Managed Care rules, regulations and compliance guidelines, patient account research and resolution, resolution of credits and issuance of refunds, identification of payment variances invoices, follow up and resolution of denied claims. PRIMARY ACCOUNTABILITIES: Quality/No Harm:  Knowledge of business office applications to include Microsoft Word and Excel as well as other standard office equipment.  Demonstrates knowledge of and supports the organizations mission, vision and value statement.  Completes work within authorized time to ensure compliance with department standards.  Maintains established benchmarks as related to assigned tasks and shows continual growth and improvement in benchmarks.  Apply Federal/State/Industry standard guidelines in order to resolve claim issues as approved by departments.  Secure needed medical documentation required/requested by payers  Maintain clean and organized work environment  Able to respond positively to stressful situations  Ability to work independently throughout the systems to access and update information as needed  Constructively participates in achieving departmental goals  Constructively participates in the team Gallup Action Plan. Customer Experience:  Demonstrates effective communication and problem solving skills.  Positively and professionally interact with customers and associates  Demonstrates the ability to work effectively as a team member  Maintains confidentiality regarding all aspects of operations Stewardship:  Processes assigned accounts timely and maintains quality standards as set by the department  Makes necessary calls to responsible parties/insurance companies for account resolution and properly documents actions within account receivable system.  Reviews and processes accounts from various department assigned reports.  Recognizes trends and escalates issues to management.  Performs other duties as assigned by management QUALIFICATIONS REQUIRED:  High School Diploma required  One year experience in Healthcare Billing and/or AR follow up or related field required  Excellent verbal and written communication skills  General knowledge of coding (ICD-9, ICD-10, CPT and HCPCS)  General knowledge of medical terminology  General knowledge of account principles  Computer experience required. Microsoft Windows applications. PHYSICAL DEMANDS:  Ability to sit at a computer for extended periods of time  Ability to multi task  Ability to work extended hours to ensure issue resolution  Ability to enter data using hand/wrist dexterity MENTAL DEMANDS:  Demonstrate good observation skills and provide possible solutions to issues  Ability to work independently  Ability to manage multiple priorities  Ability to maintain composure in an often stressful environment COMPETENCY ASSESSMENT/SKILLS CHECKLIST: SKILLS CHECKLIST For all teams: Must be able to meet and maintain the performance standards required for a position in which productivity is measured based on task. Payment Posting Team  Process daily manual insurance/patient payments and adjustment including zero pays.  Post payments, research credit balance and process in timely manner.  Perform follow up on outstanding payments and make necessary calls to ensure accurate posting.  Reviews and processes patient and insurance mail in an accurate and timely manner, making sure actions or outcomes are documented on patients account.  Daily accurate reconciliation of posting with source documents  Reviews unidentified income for resolution. Scanning Team  Reviews and processes incoming mail ensuring delivery to correct recipient.  Reviews unidentified patient and insurance correspondence in a timely manner, locating and assigning correct patient account.  Accurately scans all incoming correspondence into correct queue.  Ability to provide minor maintenance on scanning machines. Bad Debt/Charity Team  Collect and post patient payments.  Knowledge of Federal/State guidelines for government programs including charity.  Ability to respond to attorney requests for itemized bill in a timely and accurate manner.  Ability to accurately review bad debt accounts for balance adjustment/confirmation.  Communicate and interact with collection agency on bad debt accounts. Charge Entry Team  Post daily charges assigned in a timely manner for primary care or internal medicine providers including mid-level providers, such as ARNP and PA.  Review and identify error(s) on fee ticket prior to posting.  Able to correct and repost, as applicable.  Contact office, as needed, to obtain additional information to post charge and follow up to ensure resolution. Refund Team  Identify origin of credit on account: patient or insurance.  Distribute payment applicable to patient balance.  Identify insurance payment and adjustment for accuracy, for instance duplicate adjustments or posted to wrong charge.  Promptly initiate refund to patient or insurance Customer Service Team  Able to verify eligibility and benefits prior to updating patient's account.  Collect and post patient payments.  Able to distribute self-pay, OTC and prepay to balance due.  Communicate and interact with collection agency on bad debt accounts. Billing Team  Process daily Billing queues (Edit and Rejections)  Process daily billing transactions (Errors, Holds, Denials, and Rejections) and work queues.  Demonstrates ability to clearly define Errors, Holds, Denials, and Rejection messages in billing queues and take appropriate actions  Identify trends in billing queues and provide feedback when necessary. Insurance Follow up Team  Knowledge in utilizing payer website and CBO tools.  Understanding and interpret payer explanation of benefits and follow up if necessary.  Utilize coding tools when applicable to determine accuracy of denial and determine action to resolve denial.  Submit corrections, reconsideration or appeals based on payer guidelines.  Knowledge of payment and charge entry posting.  Identify payer issues including credentialing or provider eligible.  Contact insurance, office or patient to assist or obtain missing/updated information Job: *Medical Billing Organization: *Health First Medical Group LLC Title: Revenue Cycle Specialist I- HFMG Patient Business Services, Full Time Location: Florida - Brevard County-Rockledge Requisition ID: 067806