Revenue Cycle Billing Specialist

Job Description

Job Description

Revenue Cycle Billing Specialist

Reports To:  Revenue Cycle Manager

Job Summary: Responsible for the Revenue Cycle including but not limited to obtaining charge information, coding, billing, and distributing billing information. Responsible for submitting insurance claims, payment posting, follow up, payer appeals and reporting.

Role Overview:

This position is responsible for managing billing, collections, payment posting, and revenue processes to ensure timely and accurate reimbursement for services and procedures provided.

Primary Tasks and Responsibilities:

• Manages all aspects of the revenue cycle, from claim submission and insurance verifications to collections and daily, weekly and monthly reconciliation.
• Research all information needed to obtain charge information from physicians.
• Data entry of procedure charge information into EMR for billing including procedure and diagnosis codes.
• Review and submit claims accurately, ensuring compliance with payer requirements and coding best practice standards.
• Verify receipt of claims within 24 to 48 hours following submission and resubmit, if necessary to ensure receipt.
• Track and follow up on unpaid claims, working with payers to resolve denials and rejections in a timely manner.
• Weekly follow up on unpaid claims to ensure processing is completed and reimbursement is made.
• Identify denials that are eligible for reconsiderations and/or appeals, prepare and submit timely appeals ensuring all required documentation is included.
• Follow up and maintain accurate records of payer contact on status of appeals on a weekly basis.
• Address customer inquiries and complaints related to billing and collections, ensuring a professional and courteous approach.
• Post payments to client accounts, perform account research, prepare, record and process daily deposits and distribute check copies for entry into billing system.
• Maintain accurate records of all communications with clients regarding their accounts, including payment agreements and follow-up actions.
• Assist patients, front desk staff, and other practice staff with required forms, and respond promptly to questions and concerns by phone or email.
• Review, address and resolve zero payment reported on Electronic Remittance Advices (ERAs).
• Assist with returned mail to resolve and resend when necessary.
• Prepare monthly reports on the status of self-pay overdue accounts and collection efforts to management for collection list approval.

• Assist in training clinical staff in procedures required to maximize reimbursement.
• Maintain knowledge of payer contract requirements.
• Serve as a liaison between practice and contracted third party payers to maintain requirements.
• Maintain strict confidentiality and security related to clinical and financial information.
• Practice and incorporate Quality Improvement principles in daily work activities.

Performance Requirements:

• Provide back-up support to others in the department, prepare reports and perform other general administrative duties.
• Maintain required levels of productivity and performance standards.
• Meet all required work deadlines.
• Ensure that supervising manager receives proper and timely information that is relevant to business.
• Ensure compliance with all state and federal regulations including HIPAA, AAHC and other applicable governmental agencies.
• Attend required in-service training and committee meetings as requested.
• Perform other related duties as assigned.

What We’re Looking For:

Minimal Requirement:

• High school graduation or GED
• 1 year of healthcare billing experience.

Preferred Requirements:

• Billing and/or Coding Certification.
• Associates degree or 3 years of relevant experience.

Other:

• Proficient computer skills, with Microsoft Word, Outlook, and Excel.

• Excellent verbal and written communication skills

• Ability to work in a team environment.
• Ability to meet deadlines, work under pressure and with frequent interruptions.
• Ability to apply common-sense understanding and logic in day-to-day activities.
• Ability to adapt to constant change.
• Accepts accountability.
• Empathetic
• Reliable
• Self-Disciplined
• Stress Management
• Critical Thinking Skills