Revenue Cycle Specialist Physicians Office (hybrid), full time, days

Insurance Claims Specialist

Responsible for the preparation and submission of all claims (electronic and CMS 1500 formats) to insurance payers. Retrieves and processes all ANSI-837 transmission reports, claim confirmation reports and claim rejection or suspense reports. Works closely with Charge Code analyst for claim correction, resubmission and/or appeals. Responsible for all aspects of the AR including patient AR, Insurance AR, denials and appeals.

Employment Type: Full-time

Shift: Mon-Fri 8a-4:30p

Weekly Scheduled Hours: 40

Wage range: $23.30-$34.95

Weekend Frequency: N/A

Requirements:

• High school diploma/GED or higher education
• Certified Coding Specialist (C-CCS) or Certified Professional Coder (CPC)

Claim Submission

• Each day, retrieves, reviews, edits and submits/transmits all electronic direct ANSI-837, claims clearinghouse and paper claims.
• Submits all claims generated by the end of the business day.
• Achieves an error rate not to exceed 2% of claims submitted.
• Locates and retrieves all ANSI-837 final bill files for review and editing to achieve submission of "clean claims" to payors.
• Identifies all technical information that would prevent the claims from passing the payor "front-end" edits the first time submitted.
• Corrects all errors on the ANSI-837 transaction file, clearinghouse file, and/or paper claims and makes corresponding corrections in eClinical Works.
• Reports/documents errors and informs Billing Coordinator/Manager of recurring or high volume errors.
• Investigates and resolves any discrepancies between the transmission and acceptance files by the end of the business day.

IS Systems

• Navigates efficiently within the practice management system.
• Maintains a thorough knowledge of the various computer systems and programs.
• Reviews and releases claims daily for batch submission or patient statements.
• Responsible for staying current with payor websites, correspondence/communication and other coding reference material.
• Maintains a high level of proficiency in the billing and coding guidelines, policies and procedures for the various payors.
• Utilizes the practice management system efficiently and accurately updates and edits information in eClinical Works.
• Reviews clearinghouse eligibility verification and payor websites for confirmation of active coverage.
• Submits claims on a daily basis for consistent revenue management.

Accounts Receivable

• Follow up for Insurance and Patient Balances Identifies billing errors and resubmits claims when needed.
• Verifies all patient pay balances and confirms insurance eligibility prior to assigned to member.
• Identifies any discounts (self-pay, hardship, VFC) and communicates that to members as appropriate.
• Works AR trial balance reports and/or buckets monthly by payor for claims corrections and rebilling.
• Arranges and monitors payment plans for customers as needed.
• Recommends to appropriate staff refunds when necessary to members and/or payors.
• Maintains clean AR for all practices with explanations for leadership for outstanding items.

Customer Service

• Receives and processes incoming phone calls as assigned.
• Identifies customer concerns and/or complaints and strives to fine "first-call resolution" whenever possible.
• Responsible to complete all follow-up required to resolve a request, to the satisfaction of the customer.
• Retrieves and process voicemail messages within one business day.
• Maintains a professional and private environment with the customers.
• Ensure patient confidentiality while protecting the patient rights and privacy.
• Notifies Billing Coordinator/Manager immediately of any issues or concerns that haven't been resolved.

Holland Hospital is an Equal Opportunity Employer, please see our EEO policy