Rev Cycle Specialist (Prior Authorizations)

Revenue Cycle Specialist

This is a non-exempt on-site role, located at our New Providence CBO location.

Compensation Range: $21.38-$44.40/hr (Dependent on Experience)

The Revenue Cycle Specialist is responsible for billing and collecting from their assigned payor. This position ensures that all accounts are billed appropriately and meets all regulatory and compliance requirements.

Role and Responsibilities:

• Respond to inquiries from insurance carriers, via telephone, email or fax and demonstrate a high level of customer service.

• Pursue reimbursement from carriers by placing phone calls and documenting all communication in Athenahealth to ensure progress is made on outstanding accounts.

• Identify and respond to patterns of denials or trends and perform complex account investigation as needed to achieve resolution.

• Review and resolve uncollected accounts and prepare charge corrections.

• Appeal carrier denials through review of coding, contracts, and medical records.

• Call insurance companies regarding any discrepancy in payments if necessary.

• Identify and bill secondary or tertiary insurances.

• Research and appeal denied claims.

• Set up patient payment plans.

• Verify patient benefit eligibility/coverage and research ICD-10 diagnosis and CPT treatment codes as needed.

• Advise management of any trends regarding insurance denials to identify problems with payers.

• Complete required reports and assist with special projects as assigned.

Essential Qualifications:

Education/experience: High School Diploma or General Education Degree (GED) with 3 years prior hands-on experience in a fast-paced medical billing environment. Must have previous experience in a healthcare setting.

Familiarity with CPT and ICD-10 is also required; CPC certification is a plus.

Knowledge/Skills/Abilities:

• Strong communication, including writing, speaking and active listening

• Great customer service skills, including interpersonal conversation

• Good problem-solving and critical thinking skills

• Organization, time management and prioritization abilities

• Ability to be discreet and maintain the security of patient or customer information

• Effective computer skills with practice management software

• Understanding of industry-specific policies, such as HIPAA regulations for health care

• Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid

• Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.

• Effective communication abilities for phone contacts with insurance payers to resolve issues.

• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members.

• Able to work in a team environment.

• Problem-solving skills to research and resolve discrepancies, denials, appeals.

• Knowledge of medical terminology.

• Knowledge of CPT/ICD-10 and modifier coding.