Revenue Cycle Management Specialist - Group 4

Job Description

Job Description

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.

Qualifications:

• 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.