Revenue Cycle Management Specialist - Group 3

Description As a Revenue Cycle Management Specialist, you will play a crucial role in the Revenue Cycle Management (RCM) process, ensuring the timely and accurate processing of accounts receivable transactions. This position requires a detail-oriented and proactive individual who can navigate the complexities of healthcare billing and collections. You will play a pivotal role in contributing to the financial health of our clients by optimizing revenue streams and maintaining positive relationships with healthcare providers. You will serve as a resource for problem solving issues and developing account action plans. Responsibilities Build strong partnerships with Hyderabad transactional teams to support account performance excellence. Create and submit claims for medical services rendered to insurance companies and patients. Obtain supporting documentation, such as medical records, EOBs, Remits, Authorizations, referrals, etc., through email applications, scanning systems, Medicare remittance systems, etc. Review denied physician billing medical claims to ensure coding was appropriate and make corrections as needed, contact insurance companies to resolve and recover denied claims. Monitor aging reports for timely follow‑up on unpaid claims. Perform retroactive review of registration data to aid in the assurance of clean claim submittal.Accurately document claim actions taken within patient account/claims, including resolutions. Serve as a resource for problem solving issues related to registration, demographic, and insurance errors. Work collaboratively with cross functional teams, Managers, and practice staff to resolve claim and account issues. Initiative and communicate the resolution of client issues and monthly KPI trending. Adhere to HIPAA guidelines regarding confidentiality relating to the release of financial and medical information. Ensure billing and coding are correct prior to sending appeals or reconsiderations to payers. Review and identify trends or patterns of denials to prevent errors and improve conversion. Assist and coordinate with coder and billing manager concerning claim coding problems. Stay current with compliance and changing regulatory guidelines. Demonstrate knowledge of coding and medical terminology to effectively know if claim denied appropriately and if appeal is warranted. Support and participate in process and quality improvement initiatives. Achieve goals set forth by supervisor regarding error‑free work, transactions, processes, and compliance requirements. Exhibit exceptional customer service skills, answering patient and insurance calls, prompt return and follow‑up to all interactions, prompt response to requests for information, both internally and externally. Deliver timely required reports to the management team, initiate, and communicate the resolution of issues, such as payor denial trends due to coding and billing errors. Identify missing payments, overpayments, and analyze account credits. Work with collaborative group to facilitate information and resolve charge questions. Maintain accurate records of actions taken on behalf of clients to obtain reimbursement for medical services provided. Aid in reconciling deposit logs with posting reports to guarantee the integrity and precision of every transaction. Follow UnisLink’s vision and mission with regards to exceeding customer expectations. Promote UnisLink’s core values of Respect, Integrity, Customer Focus, and Continuous Improvement Ensure confidentiality of sensitive information and that all communications are handled consistent with compliance policies. Actively comply with all UnisLink policies and procedures. Other duties as assigned. Requirements Minimum of 3-5 years’ experience in a Physician Billing department working denials, appeals, insurance collections, and related follow‑up is required. Medicaid experience - specifically, AZ Medicaid Deep understanding of end-to-end claim cycle including charge / claim submission, payments and account receivables. Must demonstrate a solid ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic. Extensive experience using search engines, Internet; ability to effectively use payer websites; knowledge and use of Microsoft Products, (i.e., Outlook, Word & Excel, etc.) Knowledge of and competency with HIPAA compliance Knowledge of accepted healthcare insurance billing practices Strong customer service and communication skills, both written and verbal Strong reasoning, critical thinking, analytical and mathematical skills. Proven ability to work independently, flexibly shifting from big picture to detailed tasks, with high productivity, and regularly execute to deadlines. #J-18808-Ljbffr UnisLink