Revenue Management Specialist

Role Description

The AR management specialist works with unique department billing/collection functions to assure accounts are managed accurately and timely. Responsibilities will vary based on department need.

Qualifications

• High School Diploma or equivalency
• 4 years medical office or medical billing in a hospital or physicians billing setting, collections or coding experience
• Strong knowledge of CPT, HCPCS and ICD-9/10 codes
• Efficient in reading insurance explanation of benefits (EOB) and understanding of remittance and remark codes
• Good working knowledge of Microsoft Excel
• Good communication skills and the ability to interact well with multiple departments/levels of management

Requirements

• In depth knowledge of all payer billing and eligibility requirements
• Certified Procedural Coder (CPC) (CPC-H)
• Certified Revenue Cycle Associate (CRCA)
• Certified Medical Insurance Specialist (CMIS)
• Registered Health Information Technician (RHIT)
• Medicare billing experience preferred
• DDE Experience (Direct Data Entry) experience preferred
• Experience working hospital billing accounts in a high volume acute care setting
• Knowledge of inpatient and outpatient claim billing on UB-04
• Familiarity with EPIC billing systems
• Experience resolving claim edits, RTPs and payer rejections
• Understanding of Medicare regulations, MSP guidelines and condition code

Core Job Responsibilities

• Responsible for research and resolution of all outstanding patient and insurance credit accounts, any additional A/R management research and account updates required to ensure claims are filed to the appropriate carrier or posted correctly.
• Processing of all refunds or credit reversals in a timely manner as defined within the departmental credit/refund policy/procedures.
• Responsible for all government monthly credit reporting preparation and requirements.
• Responsible for accurate charge capture, charge review, claim edits, posting to the AR system and resolution of all charge edits.
• Responsible to handle all denials related to charge capture for improved integrity of charge capture.
• Responsible to accurately update patient demographics, insurance registration information, verification of insurance, etc.
• Responsible for the consolidation of duplicate guarantor/patient accounts within the AR management system in an accurate/timely manner.
• Responsible for the review and processing of Accounts Receivables reports to ensure revenue integrity. Reporting trends identified during the analysis.
• Responsible to research and complete a detailed analysis of all payer variances based on our Contract modeling within our AR system.
• Revenue Management Specialist must have the skill set and understanding of payer and government payer contracts/schedules in order to confirm expected reimbursement amounts are correct.
• Work closely with other departments on revenue integrity issues including variance contract build issues, charging issues, A/R type issues and other items as defined.
• Responsible for all account financial changes and refiling of those claims to the appropriate payer source.
• Assist with payer/physician credentialing and system table management.
• Responsible for electronic remittance, eligibility and claims agreements to ensure the proper processing of electronic transactions, electronic remittance requirements and other payer requirements for billing.
• Responsible for the processing of all vendor claim updates, returns and resubmissions for payment.
• Other duties as assigned.