Revenue Cycle Specialist

Revenue Cycle Specialist

The Revenue Cycle Specialist assists with various financial tasks, specifically payment and collections, for the hospital. Primarily interacts with: administration, providers, employees, clinical and non-clinical departments, patients, and insurance companies.

Essential Functions

• Work with providers and patients as necessary for enrollment, patient financials, or eligibility and authorization.
• Obtain appropriate demographic and insurance/billing information from the patient and ensure accurate data entry.
• Verify patient eligibility and/or benefits; follow up with the patient and their health plan to determine if the patient is covered.
• Complete or obtain insurance verifications and obtain authorizations or referrals as required.
• Engage directly with patients to explain their bills, resolve billing inquiries, and collect payments or set up payment plans for outstanding balances, ensuring a positive customer service experience.
• Research any payment discrepancies.
• Work queues are in the appropriate module.
• Handle denials and appeals of claims.
• Post payments received and make financial adjustments as appropriate.
• Post in the General Ledger and Accounts Receivable system.
• Pull the explanation of benefits electronically and process accordingly.
• Pick up mail from the post office and process incoming mail daily.
• Uploads EMS mail into the Digitech FTP
• Scan all the supporting documentation.
• Upload correspondence and payments to Ditech daily.
• Maintain records for the financial department on a cash flow spreadsheet.
• Distribute payment receipts to the appropriate department managers.
• Prepare the bank deposit daily and take it to the bank.
• Send out the daily cash log.
• Create client invoices and send out the bills monthly.
• Process refunds.
• Balance petty cash daily.
• Pull bank deposit transactions daily from the banks.
• Upload reports daily to the appropriate FTP.
• Create reports as required.
• Process charity care applications.
• Run reports monthly and process them.
• Process worker compensation and MVA accounts.
• Process the payroll deduction report received from HR biweekly.
• Process and send billing records.
• Assist with special projects as assigned.
• Maintain the confidentiality of patient information in compliance with HIPAA.
• Provide exemplary customer service.
• Cooperate with other personnel to achieve departmental objectives and maintain good employee relations, inter-departmental objectives, and infection control policies.
• Cordially demonstrate timeliness and professionalism in appearance, communications, and actions during all interactions and with all individuals and entities.
• Solve practical problems, dealing with a variety of issues, and interpret a variety of instructions furnished in written and oral form.
• Attend meetings as required.
• Perform other duties as requested or assigned.

Ability To Use Equipment, Tools, Materials, Machines

Computer, telephone, facsimile machine, copier, scanner, printer, calculator, and other standard office equipment.

Requirements

Education/Experience/Skills/Abilities

Education:

• Minimum High School diploma or GED required.
• College-level coursework in accounting or related field preferred.

Experience:

• Two years of similar experience required in a healthcare setting.
• Experience with and understanding of medical and insurance terminology required.

Personal Job-Related Skills / Abilities:

• Must be able to adapt quickly to changing situations.
• Ability to analyze information and make decisions using reasonable and logical judgment.
• Excellent command / highly proficient in spoken and written English; bilingual in Spanish preferred.
• Intermediate computer skills, including but not limited to: Microsoft Office – in particular Excel, electronic medical documentation, and email.
• Strong mathematical skills required.
• Must be able to adequately and quickly learn new software programs and serve as a Super User.
• Must be committed to quality and patient safety at all times.
• Must be able to communicate face-to-face and/or over the telephone.
• Must be able to work independently, and flexibly, and as a part of a multidisciplinary team.
• Must be able to manage several interruptions throughout the shift.
• Must have strong interpersonal and communication skills, verbal and written.
• Must have strong time management skills.
• Must be able to work under pressure while interacting in a helpful, courteous manner with a high degree of patient contact.
• Sufficient hearing, vision and dexterity to perform duties safely.

Physical and Mental Requirements

Physical:

• Activity Up to %: Walking 25; Squatting 10; Standing 25; Pulling 10; Kneeling 10; Reaching 35; Sitting 80; Lifting up to30 lbs 20; Pushing 10; Wrist/Finger Movements 90; Bending 25; Climbing 10

Mental:

• Stress Level Moderate to High
• Individual position core competencies:
• Quality
• Service Excellence
• Compassion
• Professionalism
• Fiscal Responsibility

Required education within first 60 days (if employee is from outside organization).

• GrahamRMC Orientation
• Department Orientation

• Continuing/Annual Education and Training:
• Falling Star Program
• Safety Storm Program

ADA REQUIREMENTS

An 'X' under the most appropriate category is marked and describes any extreme or hazardous working conditions that the job has to work under:

• Frequency of Condition

Condition 1-33% + Description

• Extreme Heat X
• Extreme Cold X
• Extreme Swings in Temperature X
• Extreme Noise X
• Working Outdoors X
• Mechanical Hazards X
• Electrical Hazards X
• Explosive Hazards X
• Fume/Odor Hazards X
• Dust/Mite Hazards X
• Chemical Hazards X
• Toxic Waste Hazards X
• Radiation Hazards X
• Wet Hazards X
• Heights X
• 34-66% + Description
• ---
• 67%+ Description
• Working Indoors X

OSHA Classification:

• Identify with a check the OSHA Job Category that describes this job. The intent is to enhance worker protection by identifying any risk in the performance of routine and reasonably anticipated job-related functions.
• __X__ Category III: Tasks that involve no exposure to blood, body fluids or tissues and Category I tasks are not a condition of employment.
• The normal work routine involves no exposure to blood, body fluids or tissues (although situations can be imagined or hypothesized under which anyone, anywhere might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first-aid or to be potentially exposed in some other way. Tasks that involve handling implements or utensils, use of public or shared bathroom facilities or telephone and personal contacts such as handshaking are Category III tasks.