Revenue Cycle Specialist Ii

SUMMARY:
The Revenue Cycle Specialist II is cognizant of the philosophy, standards, objectives and policies of the Department and the Organization. This position requires advanced working knowledge of medical accounts receivable billing and collections. Must demonstrate the ability to complete work in designated area of accounts receivable with measurable results. Staff in this position is required to meet standards and goals within their designated area of accounts receivable.
Designated areas of responsibility include but are not limited to the following:
1. Self-pay/Sliding Fee
2. Managed Care Plans
3. Medicaid
4. Medicare
5. Commercial Plans
6. Payment/denial posting
RESPONSIBILITIES:

• Ability to perform clerical/technical/service/administrative tasks.
• Ability to identify, analyze, and research denial patterns.
• Maintains complete understanding of assigned area of accounts receivable.
• Able to identify and resolve credit balances.
• Assures collections of designated accounts receivable are accomplished through proper follow-up and adherence to existing policies and procedures for that area.
• Reviews all correspondence on a daily basis for denials and short paid claims.
• Reviews and processes all Explanation of Benefits for designated accounts.
• May be tasked to post payments and denials for designated accounts upon receipt.
• Performs work queue activities according to designated account receivable area's policies and procedures. This is a method whereby designated accounts will be worked on a daily basis. A minimum number of accounts worked to be determined by management.
• Performs corrections as required based on information found on Error Reports, various work queues or other methods as assigned. This includes both internal and external errors and is to be reviewed and corrected on a daily or weekly basis.
• Communicates to management information related to changes required for designated area to facilitate the collection of accounts receivable.
• Works Aged Accounts Receivable on a daily/weekly basis to ensure that designated accounts are processed timely and work queues are kept current according to the standards set by the department. This will be done via various work queues and reports.
• Verifies and performs data entry of patients' personal/insurance information as needed to assist in payment of debt for designated accounts.
• Responds to incoming telephone, mail and email inquiries from patients, providers and payers regarding outstanding balance.
• Interacts with other departments, insurance companies, medical professionals and patients' on daily basis.
• Recognizes issues relating to provider credentialing and payer contracts and communicates such information in a timely manner to their manager for escalation.
• Maintains familiarity with the Institute fee schedules as well as CPT and ICD-10 coding and keeps up to date on annual changes.
• Maintains patient/employee confidentiality in the management of protected information
• May be responsible for Claim Printing/Reviewing of printed claim forms for accuracy to ensure claims are paid timely.
• May be responsible for the submission of electronic claim and/or patient statement files depending on designated accounts receivable.
• May post charges as assigned for sites without automatic entry of electronic encounters.
• May be asked to participate in new staff orientation programs to familiarize them with coding and billing procedures and policy updates as deemed necessary.
• May be asked to assist with special projects.
• Participates in the department's performance improvement activities.
• Maintains patient/employee confidentiality in the management of information.
• Observes the Health Care System's compliance policies.
• Participates in the development of other staff members as needed.

SKILLS:

• Experience with collections, commercial insurance, billing, medical terminology, CPT, ICD-10
• Typing/keyboarding and data entry skills
• Experience creating and maintaining Excel spreadsheets
• Strong customer service skills
• Effective in taking action with being told (self-motivated, take initiative).
• Ability to maintain cooperative, friendly and mutually supportive work environment: a "team" player
• Ability to maintain congenial, professional, courteous, and respectful attitude in dealing with co-workers, payers, patients, and outside community
• Excellent verbal and written communication skills
• Ability to deal calmly with individuals under stress

QUALITIFICATIONS:

• HS Diploma or GED required
• Associates Degree in Business, Accounting, or Healthcare preferred
• Medical Billing & Coding or Medical Administrative Assistant Certification
• Minimum of two (2) years of medical billing and/or collections experience or one (1) full year IFH experience as a Revenue Cycle Specialist I required
• Knowledge of CPT and ICD-10 Coding required

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