Revenue Cycle Specialist

EOE Statement
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

About the Organization
Wills Eye Hospital, located in Philadelphia, Pennsylvania, is a global leader in the treatment of eye disease. Established in 1832 as the America's first eye hospital, we are one of the world's premier eye care facilities and the #2 best hospital in the nation for ophthalmology as ranked by U.S. News & World Report.

Our clinical expertise, state-of-the-art diagnostic testing and advanced surgical capabilities make Wills Eye a worldwide referral center where more than 250,000 patients are treated annually. From common eye problems to rare sight-threatening diseases, Wills Eye provides general eye care and comprehensive ophthalmic specialty services that attract patients throughout the Philadelphia metropolitan area, across the country and around the world.

Today, we continue to shape the science and medicine of ophthalmology, thanks to our talented, skilled physicians and staff who are dedicated to improving and preserving sight.


Description

The Revenue Cycle Specialist is responsible for providing top-notch billing services while ensuring accuracy and efficiency in managing inpatient claims.

1. Prepares and submits billing data and medical claims to insurance companies, ensuring accurate coding.
2. Ensure the patient's medical information is accurate and up to date.
3. Post payments to the system, review Electronic Remittance Advice (ERA) for accuracy, and alert the AR follow-up team of any denials.
4. Report trends in denied claims or payment discrepancies to Business Office management.
5. Accurately bills inpatient medical claims within established timelines and initiates dialog with payors, patients and departments.
6. Reviews billing documents as assigned for submission to insurance plans and government entities (Medicare, Medicaid, Tricare etc). Clearing all edits necessary for clean claim submission.
7. Understands payor contracts and can apply calculations to resolve under/overpayments.
8. Submits reconsiderations and appeals related to denials using payor documentation and portals.
9. Interacts with third party payors and patients to resolve account balances.
10. Escalates claims to proper management personnel when unable to achieve clean claim status for submission.
11. Reviews EOB's/RA's (Explanation of Benefits and Remittance Advice documents received from insurance payers and government entities.
12. Processes all required payments, adjustments to accounts when claim payment is received if required in client or company systems.
13. Contact insurance plans and governments entities using online systems, email, and phone to resolve unpaid claims.
14. Independently responds timely and accurately to all requests. Interacts professionally and courteously with employees and internal and external stakeholders.
15. Effectively monitors assigned work queues and workload, ensuring resolve of accounts in a timely and accurate manner.
16. Performs other duties as assigned.

Position Requirements

Educational requirements:

• Bachelor's degree preferred. High school diploma or GED required.

Licensure:

• Associate or Industry Certification is a plus

Experience:

• 1-2 years of healthcare revenue cycle experience within a Hospital setting required
• Demonstrated understanding of, healthcare terminology, insurance plans and contract language preferred.
• Knowledge of medical terminology such as CPT, HCPCS, APC, ASC, DRG and ICD10.
• Strong proficiency in Microsoft Excel
• Ability to communicate clearly (both written and verbal)
• Knowledge of State and Federal healthcare guidelines and regulations
• Experience working with Epic or other related EHR preferred
• Demonstrated experience with reviewing outstanding balances to resolution (Medicare, Medicaid, and Commercial payors).
• Exceptional time management and organizational skills.
• Ability to direct work with minimal supervision and ability to meet performance and quality goals.

Category
Accounting/Finance

Full-Time/Part-Time
Full-Time

Position
Revenue Cycle Specialist

Number of Openings
2

Exempt/Non-Exempt
Non-Exempt

Location
Wills Eye Hospital


This position is currently accepting applications.