Revenue Cycle Specialist

JOB SUMMARY
The Revenue Cycle Specialist at North Mississippi Health Services is responsible for facilitating effective Revenue Cycle flow, which includes bill processing and resolution, denials and appeals management, and recurring reporting generation to monitor status and performance. This role operates under the guidance of the Billing Manager and requires an experienced individual with knowledge of third party payers and contracts and excellent organizational, analytical, and communication skills to effectively interface with third party payers, vendors, and staff in claims review, analyze reports and claims to identify underpayments and trends, and facilitate action to support claim resolution and payment capture to promote overall effective and efficient area function and the financial health of the organization.

JOB FUNCTIONS
Billing & Follow Up:

* Processes Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format.
* Conducts billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim.
* Facilitates information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment.

Denial Management:

* Manages denial receivable to resolve accounts.
* Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
* Analyzes denials to determines reason they occurred.
* Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager.
* Takes corrective action through systematic and procedural development to reduce or eliminate payment issues.

Contract Management:

* Maintains familiarity with payer methodologies and the ability to communicate with NMHS staff.
* Manages paid claims to resolve underpaid accounts.
* Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
* Analyzes underpayments to determine reason they occurred.
* Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager.

Communication:

* Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance.

Liaison:

* Contacts insurance companies regarding denial, underpayments or rejection issues.
* Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues.

Reporting:

* Assists in preparation of monthly denial reports and other denial reports as requested.
* Assists in preparation of monthly variance reports and other variance reports as requested.

Regulation:

* Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
* Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.

QUALIFICATIONS

Education

* Bachelor's Degree in Business, coding or equivalent field. Required
* Associate's Degree Willing to consider 4 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required
* High School Diploma or GED Equivalent Willing to consider 8 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required

Licenses and Certifications

Work Experience

* 1-3 years
* 1-3 years

Knowledge Skills and Abilities

* Excellent analytical and problem-solving skills
* Good organizational and communication (written and verbal) skills
* Excellent interpersonal skills
* Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites
* Must be able to research, analyze and communicate payer trends to identify reimbursement and training issues
* Must professionally and effectively communicate with third party carriers, vendors, and hospital contacts to promote contractual compliance
* Must provide input and help design payer report cards in conjunction with contracting, managed care, and other revenue cycle departments
* Must serve as member of the Denials Committee
* Must conduct training sessions with Billing and Follow-up staff as needed
* Must have effective negotiating skills, including the ability to resolve difficult claims issues
* Must be able to gather and share information with knowledge, tact, and diplomacy
* Must have extensive contact with: patients, payers, physician office staff, coding staff, Credentialing, Case Management, various Department heads, and all staff within the department

Physical Demands

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

* Standing . Constantly

* Walking . Frequently

* Sitting . Rarely

* Lifting/Carrying . Frequently 50 lbs

* Pushing/Pulling . Frequently

* Climbing . Occassionally

* Balancing . Occassionally

* Stooping/Kneeling/Bending . Frequently

* Reaching/Over Head Work . Frequently

* Grasping . Frequently

* Speaking . Occassionally

* Hearing . Constantly

* Repetitive Motions . Constantly

* Eye/Hand/Foot Coordinations . Frequently

Benefits A vailable

* Continuing Education
* 403B Retirement Plan with Employer Match Contributions
* Pet, Identity Theft and Legal Services Insurance
* Wellness Programs and Incentives
* Referral Bonuses
* Employee Assistance Program
* Medical Benefits
* Dental Benefits
* Vision Benefits
* License + Certification Reimbursement
* Life, Long-Term and Short-Term Disability, Group Accident, Critical Illness and Hospital Indemnity Insurance
* Employee Discount Program
* Other:
* Early Access to Earned Wages
* Tuition Assistance
* Relocation Assistance
* Paid Time Away
* Special Employee Rates at NMMC Wellness Centers

_We believe a career is more than just a career - it's a calling. Our teammates' ""True North"" is what calls them to health care; it's their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love._


#NMHSConnections
recblid xp9197v7c4j4ie87lm47wigyypb85a