Revenue Cycle Specialist

Job Title

Below is a listing of job duties/responsibilities:

Maintains detailed knowledge of revenue cycle functions.

Reviews and completes work log tasks in the system by working through claim edits, denials, and aging tasks; turns in daily productivity reports as required.

Works accounts receivable to ensure timely payments from insurance.

Initiates claim submissions, performs account review, and ensures work is accurate and complete.

Identifies trends, conducts follow-up, and performs root cause analysis on unpaid accounts.

Responds to inquiries and calls from patients or staff members.

Reviews websites, bulletins, and other resources to maintain current knowledge of regulatory requirements and relays information to Manager and team members.

Performs insurance eligibility verifications and updates patient coverage as needed.

Reviews charges for accuracy, completeness, modifiers, and medical necessity; corrects as necessary and submits timely. Corrects and resubmits rejected claims.

Manages work queues for assigned providers; follows up with third-party payers on unpaid or denied claims via portals, phone, chat, email, and appeals as necessary.

Documents contact with insurance companies and others using appropriate designated methods.

Manages and responds to payer requests for information/medical records for claim adjudication.

Communicates with patients about billing inquiries and discrepancies.

Works as part of a cohesive team, providing coverage for other team members as needed.

Performs additional duties as assigned.

Qualifications

Team Player: Works well as a member of a group

Enthusiastic: Shows intense and eager enjoyment and interest

Dedicated: Devoted to a task or purpose with loyalty or integrity

Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

Self-Starter: Inspired to perform without outside help

Preferred: 2 years Revenue cycle/Billing

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