Revenue Cycle Specialist

Revenue Cycle Specialist

The Revenue Cycle Specialist will work directly with all revenue cycle functions, including customer service, accounts receivable, billing and collections and patient access functions. The Specialist will ensure timely, legally compliant and accurate billing in order to maximize cash flow related to the collections of Accounts Receivables (A/R). Will be a subject matter expert of CMS, Medicare, Medicaid and other primary Third-Party payor rules and requirements for Critical Access Hospital and Rural Health Clinic billing.

Essential Duties and Responsibilities:

• Manage and work assigned patient accounts throughout the revenue cycle process, from billing through final resolution.
• Review patient accounts for accuracy of charges, payments, adjustments, insurance information, and balances.
• Perform insurance follow-up on unpaid, denied, rejected, and underpaid claims.
• Research and resolve claim denials, including identifying the cause of the denial and taking appropriate corrective action.
• Submit corrected claims, appeals, reconsiderations, and other required documentation to insurance companies.
• Monitor accounts receivable and prioritize accounts based on aging, payer, balance, and financial impact.
• Identify and resolve billing errors, payment posting issues, incorrect adjustments, and account discrepancies.
• Review and work insurance aging reports and assigned work queues according to established department standards.
• Verify insurance eligibility, benefits, authorization requirements, and other payer information as needed.
• Review accounts for missing charges, coding issues, demographic errors, and other items that may prevent accurate and timely reimbursement.
• Communicate with insurance companies, patients, providers, and internal departments to resolve account issues.
• Process and review patient refunds and credit balances in accordance with organizational policies and applicable payer requirements.
• Research and resolve credit balances, unapplied payments, unidentified payments, and other payment discrepancies.
• Assist with identifying trends in denials, billing errors, and payment issues and communicate recurring problems to leadership.
• Maintain accurate and detailed account documentation, including standardized notes regarding research performed and actions taken.
• Follow established revenue cycle workflows, policies, procedures, and payer requirements.
• Assist with month-end and other revenue cycle reporting as assigned.
• Maintain confidentiality and comply with HIPAA and applicable federal and state regulations.
• Assist with training and supporting other revenue cycle staff as needed.
• Participate in process improvement initiatives designed to improve reimbursement, reduce denials, improve A/R performance, and enhance the patient financial experience.
• Perform other duties related to revenue cycle operations as assigned by the Revenue Cycle Supervisor or Revenue Cycle Director.
• Develops service, education and training programs throughout the company relating to the patient revenue cycle experience.
• Assist with special projects as assigned.
• Reports mistakes, near misses, adverse events, quality and safety concerns.
• Participates in the development and implementation of safety and quality improvement activities.
• Maintains patient confidentiality and upholds HIPAA laws.
• Other duties as may be assigned.

Job Requirements:

Education: Bachelor's Degree in Accounting, Healthcare Finance or related field preferred.

Licensure/Certification: N/A

Experience: Experience in Patient Accounts in a hospital or clinic setting, Critical Access Hospital (CAH) and Rural Health Clinic (RHC) preferred. Strong knowledge of revenue cycle operations including financial counseling, coding and billing. Previous experience working with EHR billing systems and strong computer skills required.

Physical Requirements: Frequent sitting and occasional standing and walking. Occasionally lift 10 pounds. Frequent bending, stooping, and reaching.