Job Summary and Objectives

Under the general supervision of the Director of Revenue Cycle Operations, the Revenue Cycle Specialist participates in all aspects of insurance submissions and AR follow-up while adhering to HIPAA compliance, privacy, and confidentiality standards.

Essential Responsibilities and Tasks

• Demonstrate knowledge of timely filing deadlines, payer appeals, and researching payer policies.
• Manage follow-up work queues.
• Resolve patient billing and insurance concerns received via voicemail messages and e-mail.
• Communicate with patients as needed to resolve denials and pending claims.
• Generate patient correspondence to be transmitted through mail or electronically.
• Submit outbound referrals
• May assist with insurance communication, revenue cycle collections, claim edits, charge entry, cash research, as needed.
• Review data on insurance explanation of benefits (EOB’s) to ensure accurate payment posting.
• Completing secondary crossover (Electronically or On Paper).
• Updating the correct payor and resubmission of claim(s)
• Access necessary online portals to obtain payment documentation.
• Identifies any payments not being paid at the allowed/contracted amount and communicates this to the appropriate RCM leadership personnel – Team Lead, Supervisor, Manager
• Submit and maintain correspondence as requested and required to ensure payment is received.
• Assist other projects as needed.
• Maintain accurate and thorough records.
• Demonstrate the ability to act as a team player in a professional and positive manner.
• Perform other duties as may be assigned by the Manager, Revenue Cycle.

· Participate and engage in an Interactive process with other team members and Supervisors

· Adhere to All Applicable Policies and Procedures.

· Clearly Articulate Operational Problems and Positively Contribute to Solution Development

Required Competencies and Skills

§ Excellent interpersonal and customer service skills

§ Excellent verbal and written communication skills

§ Excellent attention to detail

§ Strong Office Skills such as Typing and Filing

§ Advanced Understanding of frequently used Microsoft Office software such as Word, Outlook, and Excel.

§ Strong Understanding of various insurance plans

§ Strong understanding of Healthcare Terminology

§ Ability to work independently on assigned tasks as well as to accept direction on given assignments.

§ Deals with confidential information and/or issues using discretion and judgment.

§ Ability to identify and resolve team issues.

§ Ability to be proactive and take initiative.

Working Conditions and Physical Requirements

§ Frequently adjusts or moves items weighing up to 50lbs across office for various needs.

§ The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.

§ Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, computer, phone.

§ The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.

§ Constantly remaining in a stationary position. Standing or Sitting for Prolonged Periods

§ Must be able to wear personal protective equipment, such as KN95 masks most of the day

§ Must have Sufficient Ambulatory ability to move to various locations.

Education and or Experience Requirements

§ Undergraduate Degree in Relevant Field (Required)

§ Graduate Degree in Relevant Field (Preferred)

§ 1 Years or More of Demonstrated Skill in Similar Position (Preferred)

§ 3+Years of More Experience in Revenue Cycle Department (Required)

§ CPC Certification (Preferred)

§ Internal candidate: No disciplinary documentation in the last 6 months, satisfactory attendance, satisfactory team attendance/proper progressive discipline on file.

Other Requirements

§ Valid California Driver’s License

One of the Nations Leading Medical Groups specializing in the treatment of diseases affecting the retina, the vitreous and the macula using State of the Art D