Revenue Cycle Specialist

LHH is seeking a Revenue Cycle Specialist for an incredible Healthcare company in Mesa, AZ. You will be responsible for ensuring proper follow-up on the back-end aspects of Revenue Cycle processes related to reimbursement. Manage projects, escalate problems and issues, and oversee accounts receivable management and research. Ensure compliance with internal and external policies and procedures. Monitor payments, fee schedule changes, health plan reimbursement changes, and other factors that affect revenue, cash collections, and adjustments. In addition, you will ensure proper revenue booking by conducting regular monitoring and analysis. See the qualifications below and apply!
 
Responsibilities:
Payment and collection process for agency billed claims duties:
 

• Performs full cycle billing and collections functions including a detailed review of billing and collection activities.
• Interprets and analyzes EOBs, remits, and payment posting entries.
• Checks claim status from payers through telephone, websites, and any other communication deemed necessary for insurance carriers in a prompt and efficient manner.
• Collects on insurance accounts by contacting insurance carriers and other third-party payers to verify receipt of billing and other information needed to process claims.
• Secures approximate date of payment, negotiates with claims personnel for prompt payment and resolves discrepancies in billing within appropriate time frames.
• Categorizes and quantifies payer payment issues for resolution and reporting to Rev Cycle Manager.
• Reviews and interprets explanation of benefits to determine contractual compliance, accuracy of payment received, true patient responsibility, status of denied or reduction of service coverage, and follows up appropriately.
• Researches, identifies, and rectifies any special circumstances resulting in delayed payments.
• Works aggressively with health plans regarding accounts that have aged over 30, 60, and 120 days.
• Research claims that have been paid incorrectly and ensures prompt payment.
• Collaborates effectively with Revenue Specialist I, Billing Coordinator & Payer in a timely manner to resolve billing problems and disputes.
• Monitors the billing and collection electronic charge entry processes to ensure days in accounts receivable are minimized.

Back-end claim processing and denial reconciliation duties:
 

• Post all third-party payments, denials, and adjustments.
• Follow up on outstanding claims via payer websites and IVR systems.
• Investigate denials and verify completeness and accuracy of program billing by collaborating with assigned staff.
• Reconcile claims submission with payments and denials as reflected on an Explanation of Benefits and resubmit denied claims within 30 days of receipt.
• Draft correspondence to payers including 1st level appeals for technical denials and corrected claim memos.
• Work with Billing Coordinator to properly route adjudicated statuses that cannot be entered into the appropriate system.
• Review accounts receivable activities and call on outstanding balances or claims.
• Research payer credit balances and regularly write up requests for refunds.
• Manage worklists and reports for the reconciliation of unpaid or denied claims.
• Work closely with Department Leadership and Credentialing Department to troubleshoot contract and provider credentialing issues resulting in unpaid, denied, or short pay claims.
• Ensure timely and proper reimbursements by researching and resolving all aged receivables.
• Perform basic Payer contract management by assessing payer performance and payment accuracy according to contractual language.

 
Qualifications:

• High school diploma/GED and/or or equivalency of education and years of experience, required.
• College or certification course work, preferred.
• 2+ years of experience in medical claims, required.
• Proficient in Nextgen and Aura software, preferred.
• Familiar with behavioral health knowledge, preferred.
• Ability to obtain and maintain Level One fingerprint clearance and meet agency personnel requirements, required.

 
Employment Type:

• Contract-to-hire
• Full-time opportunity

 
Pay Rate:

• $20-$23/hr, depending on experience
• Benefit offerings


Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.
 
If you are interested in learning more about what this role entails – apply today for immediate consideration! Not Interested? Explore numerous other opportunities LHH Recruitment Solutions has to offer by visiting www.lhh.com.


Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.lhh.com/us/en/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records