Overview

Revenue cycle specialist is an account receivables and billing expert who will perform necessary tasks for revenue cycle management including but not limited to claims management, A/R and denials follow-up and resolution, payment posting and collections management, Payer enrollment/credentialing and privileges, Authorization management.

Key Role Responsibilities

• Perform a variety of RCM functions such as charge and payment posting, obtaining and tracking authorizations, processing of electronic EDI claims and electronic Explanation of Benefits (EOBs), follow-up on outstanding or denied claims, receivable management tracking and reporting, credentialing and privileging
• Responsible for accurate and timely insurance claims follow-up and accounts receivable resolution with payers including appeals and submission of corrected claims
• Accountable for aged claims and special accounts receivable projects

• Adhere to government regulations, payer contracts and insurance guidelines when performing insurance follow-up, resolving open accounts and appealing claims
• Be a key contributor to the Revenue Cycle by identifying and reporting inefficiencies and opportunities that enhance revenue flow, decrease denials and minimize write-offs
• Respects and adheres to rules and regulations regarding patient confidentiality, HIPAA, and handling PHI (Privileged Health Information)

Skills Requirements

• Exceptional detail orientation, critical thinking, analytical and problem-solving skills
• Proficiency in government, commercial and/or insurance payer claims follow-up, denial resolution and appeals processes
• Ability to interpret and apply insurance payer billing guidelines, claim rules and contract terms
• Knowledge of CPT and ICD coding systems
• Ability to collaborate and work cohesively as part of a team
• Strong communication skills, both written and verbal
• Excellent interpersonal and customer service skills to interact and maintain relationships with a wide range of personalities
• Strong organizational skills necessary with strong accountability and drive
• Demonstrated proficiency with databases and spreadsheets
• Able to cope with interruptions, be flexible, and be a team player

Key Agency Responsibilities

In addition to role responsibilities, every staff member has the following responsibilities as a part of their employment:

• Models and reinforces the core values of dignity, authenticity, hope, justice, passion and balance
• Actively participates in performance improvement and advocacy activities that support the mission
• Protects clients’ personal health information by maintaining compliance with HIPAA and other relevant health care-related IT security regulations
• Performs other duties on an as-needed basis

Knowledge, Experience, and Skills

Formal Education and Training

• Associate’s degree or equivalent experience
• Certified Professional Coder (CPC) certification preferred

Experience

• Two years or more revenue cycle experience in a health care setting required
• Experience in and knowledge of Medicare/Medicaid/Commercial payer guidelines
• Experience with Athena Practice Management would be a plus.
• Familiarity with insurance verifications and prior authorizations is preferred
• Experience working in a federally qualified health clinic (FQHC) is highly desirable
• Comfortable working with homeless and/or low-income individuals and families