Revenue Cycle Coordinator - Sycuan Health Center

Revenue Cycle Coordinator

The ancestors of the Sycuan Band of the Kumeyaay Nation existed many centuries ago as a community of peoplea Tribe living together, farming, hunting and fishing to survive. Much has changed since that time. Today the Sycuan Tribe governs its Reservation, owns and operates a Casino and a Golf Resort, and owns a number of other business ventures in the San Diego Region. One attribute that remains unchanged, however, is Sycuan's sense of community. Sycuan is more than just a business. Sycuan is a community of people working together toward a common goal. Whether you work in our state-of-the-art Casino, our beautiful Resort, or become a staff member in our Tribal Government division, you will be part of the Sycuan family.

Are you detail-oriented, organized, and passionate about making a difference in healthcare? As a Revenue Cycle Coordinator, you'll play a vital role in ensuring the success of Sycuan Health Center by supporting billing operations, claims processing, payment reconciliation, and patient account services. This fast-paced role offers the opportunity to collaborate with healthcare professionals, external partners, and patients while helping drive exceptional service and operational excellence.

Job Purpose/Summary: Under the supervision of the Executive Director and a third-party consulting firm, the Revenue Cycle Coordinator's primary responsibilities are to communicate, coordinate and facilitate with remote outsourcing company requests and needs for efficient and timely completion of assigned revenue cycle workload. In addition, apply patient visit payments, work with clinic management and outsourcing company for the completion of accurate encounter entry for timely submission of encounter data for claims processing. The Revenue Cycle Coordinator must perform duties in line with the Health Insurance Portability and Accountability Act (HIPAA). It is the responsibility of the Revenue Cycle Coordinator to know his/her limitations and abide by the regulatory standards. This role requires excellent interpersonal and customer service skills, must be courteous and helpful, and possess the ability to meet and speak with the public as the "first contact" of the clinic while aligning his/her duties with Sycuan Medical Dental Center values.

Essential Duties and Responsibilities:

1. Administrative Functions:
• Must become proficient in the use of the NextGen EHR practice management software system, including learning and applying new functionality as needed.
• Have knowledge of payer billing requirements {MediCal, Medicare, Patient Eligibility Payment Programs, and Commercial Insurances).
• Scanning of documentation, EOBs, and any other requested information to SharePoint via process and protocols.
• Obtain all remits for posting i.e. Download from websites, ERA files, etc.
• Maintain deposit reconciliation with finance and keeping record of reconciliation log.
• Post all insurance and patient payments and adjustments in practice management system.
• Coordinating/Resolving issues that hold up claim approval claim issues that cannot be handled off-site i.e. registration updates.
• Coordinating/Resolving issues that hold up account adjudication denial/aged issues that cannot be handled off-site i.e. missing EOBs.
• Coordinating with clinic/dental staff to resolve deficiencies.
• Prepare and send patient statements monthly and maintain regular schedule for sending out billing statements in accordance with the Financial Policies and Procedures.
• Patient phone calls regarding statements.
• Create patient payment plans when needed.
• Maintain and process for review of all billing statements which are returned to sender. Utilize public records and other resources to make best effort to obtain accurate billing addresses.
• Assist billing department outsource company personnel as necessary.
• Answers all incoming calls within 3 rings and makes patients calls in a courteous and professional manner.
• Willingness to help and maintain professional relationships with coworkers.
• Performs other duties as needed.
• Attends all staff meetings.
• Observes and acknowledges all SMDC policies and procedures.
• Always greets patients, visitors, and providers in a courteous and respectful manner; responds to patients with empathy and positive interpersonal skills; consistently handles all requests in a positive manner.
• Receive and sort all incoming mail from internal and external sources to include but not limited to US Post Office and other courier services.
• Accounts Receivable: responsible for AP email, print and code all invoices to be paid before sending to Tribal Accounting, and contact vendors in regards to discrepancies, questions or requests.
• Responsible for the eFax email account. Distribute all incoming faxes to appropriate Clinic Dept.
2. Fire Department Functions:
• Responsible for Fire Department billing workflow; daily charges, daily claims and weekly statements.
• Handles reimbursements from CorrectCare, Medi-Cal, Molina and AMR.
• Submit quarterly reports to DHCS for GEMT QAF.
• Responsible for accounts receivables.
• Point of contact for all ambulance billing/trip questions/concerns.
• Assist with the GADCS reporting.
• Contact EMTs and hospital to gather missing information about patients or trips.

Job Specifications:

Education & Experience:

Essential:

• Graduate of approved high school or GED equivalent
• Current CPR certification
• Available for all shifts/assignments and, when required, able to work evenings and weekends

Desirable:

• CPC (Certified Professional Coder) or CPB (Certified Professional Biller) certification or apprenticeship
• Previous medical field experience and/or receptionist, data entry experience
• Tribal Clinic experience
• Multi-lingual

Knowledge, Skills, and Abilities:

• Excellent English oral and written communication skills
• Excellent knowledge of medical clinic protocols
• Ability to complete forms and documents
• Ability to prioritize and perform multiple tasks
• Ability to maintain confidentiality
• Ability to appear for work at scheduled time
• Ability to maintain professionalism and composure
• Ability to accept constructive criticism
• Excellent knowledge of laws and regulations governing medical records and medical office management
• Ability to provide excellent internal and external customer service

Physical and Mental Requirements:

• Able to lift/move up to 40 pounds, move from place to place, and stand for long period of time
• Ability to do math, organize and prioritize workload, work effectively and efficiently under stress
• Ability to supervise, multitask, understand and follow instructions
• Ability to proficiently read, write, speak and understand English

Safety:

• Ensure compliance with policies and procedures related to safe work practices
• Uses all appropriate equipment and/or tools to ensure workplace safety
• Immediately reports unsafe working conditions
• Follow all infection control procedures including blood-borne pathogen protocol
• Be familiar with and know locations of Safety Data Sheet Binder

Privacy/Compliance:

• Maintains privacy and security of all patient, employee, and volunteer information and access to such information. Such information is accessed on a need to know basis for business purposes only.
• Complies with all regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent or unlawful behavior or activity.
• Upholds strict ethical standards.

If you enjoy being part of a community dedicated to creating a memorable guest experience, we invite you to explore career opportunities with Sycuan and join our winning team!