Job Location

Remote Type

Position Type

Job Summary: The Revenue Cycle Specialist is responsible for timely follow up, denial review, corrections and appropriate reimbursement for all claims billed for all insurance payers. Duties include identifying and possessing working knowledge of claim life cycle in revenue cycle process.

Job Responsibilities:

• Complete analytical review of claim payments using 835 claim detail information
• Electronically or manually reconcile and balance all payments received
• Prepare batch summary sheets using data from various reports
• Consistently observe documentation standards
• Communicates directly with payers to follow up on outstanding claims, file technical appeals, resolve payment variances, and ensure timely reimbursement.
• Identifies and analyzes denials and payment variances and takes action to resolve account including drafting and submitting appeals.
• Examines denied and underpaid claims to determine reason for discrepancies.
• Ability to identify with specific reason underpayments, denials, and cause of payment delay.
• Works with management to identify, trend, and address root causes of issues in the A/R.
• Identify and resolve all basic errors related to reconciliation.
• Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of client/payer contracts and reimbursement trends.
• Reads through healthcare contracts and contract language and ensures proper workflows are established.
• Research remittances and Explanation of Benefits (EOBs) for complete accurate payments or denials.
• Work with customer/payers to understand specific reasons for variances and/or denials and measures to prevent future denials.
• Research customer/payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned.
• Submit corrected claims and appeals.
• Coordinates appeals with clinical or coding areas within the revenue cycle.
• Requests appropriate adjustments, when required.
• Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues.
• Manage assigned accounts, ensuring claims accounts receivables balances are closely monitored, which includes resolving issues as needed.
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
• Must meet productivity and quality standards.

Requirements:

• Bachelors degree and minimum three (3) years experience in billing and claims processing.
• Knowledge of HIPAA and patient privacy rules
• Ability to work independently and seek supervision appropriately.
• Must be well organized, able to multi-task, detail oriented, and able to complete projects and assignments in a timely manner.
• Needs to be a strong problem solver and critical thinker to resolve accounts.
• Excellent verbal and written communication skills and ability to interact well with team members from other departments.
• Flexibility and ability to respond to changing priorities.
• Computer proficient (experienced with Microsoft Office Suite, pivot tables, EHR, General Ledger systems and Clearing House programs).