Senior Revenue Cycle Specialist

Revenue Cycle Management Specialist

This position is responsible for the entire revenue cycle process, ensuring efficient billing, collections, and compliance with regulations. This role plays a crucial part in maximizing revenue and minimizing losses for the organization within the Revenue Cycle Management department.

Responsibilities

• Follows-up with patients and payers and ensures outstanding balances are paid accurately
• Makes calls to and takes calls from patients, discussing their account in detail
• Contacts insurance plans to determine eligibility and obtain coverage and benefit information
• Contacts insurance plans to obtain prior authorization for services
• Accurately reviews outstanding insurance and patient credit balances to determine appropriate party to refund
• Responsibilities will include accurately posting payments, adjustments and refunds as necessary
• Responsible for reviewing and gathering appropriate documentation for payor requested Risk Adjustment Audits. Coordinates on site chart pulls as appropriate
• Reviews and appeals unpaid and denied claims, includes analysis of coding that Analyze daily financial exceptions from the charge capture audit reports to determine areas of leakage and partner with information technology and clinical service lines to rectify charge capture issues by assisting service lines to improve their ability to capture compliant charges
• Manages the processing and submission of provider enrollment applications with the payers in a timely and accurate manner
• Scanning all incoming mail and distributing according to department policy
• Meets or exceeds productivity standards in the completion of daily assignments and accurate production
• Deposits checks and other payments confirming that all necessary documents are properly authorized, are in proper form, and are within authorized limits
• Develop and maintain a current in-depth knowledge of all Banking transactions to include EFT, ERA, Paper, Check and all document handling and management
• Performs all other assigned duties

Qualifications

• 7 years medical billing experience
• Ophthalmology background desired
• Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies
• Demonstrated computer literacy
• Well-organized with attention to detail
• Ability to read and understand oral and written instructions
• Excellent math skills
• Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients
• Professional customer service skills
• Have a desire and dedication to work with self-discipline
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations
• Prior experience working full cycle revenue in the healthcare setting

Benefits & Perks

Your health, happiness and your future matters! At AVP, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!