REVENUE CYCLE SPECIALIST I

SUMMARY:

The Revenue Cycle Specialist I is cognizant of the philosophy, standards, objectives and policies of the Department and the Organization. The representative shall have a basic understanding of medical billing and collections and will provide support to senior representatives to facilitate the collections of accounts receivable. Staff in this position must be able to complete basic tasks within the department which requires the ability to perform administrative, data entry, and /or customer service duties.

RESPONSIBILITIES:

• Maintains complete understanding of designated accounts.
• Assures the smooth operation of designated accounts receivable through proper follow-up and adherence to existing policies and procedures for the assigned area.
• Reviews and processes correspondence on a daily basis.
• Reviews and processes Explanation of Benefits for designated accounts and posts payments and denials accurately upon receipt.
• Provides clerical support to senior representatives such as mailing paper claims, preparing spreadsheets for appeals, or maintaining data spreadsheets as directed by the manager (s).
• Communicates to management information related to changes required for designated areas to facilitate the collection of accounts receivable.
• May be responsible for specific Aged Accounts Receivable’s on a weekly basis to ensure that designated accounts are processed timely. This will be done via various work queues and reports.
• Verifies eligibility and performs data entry of patients’ personal/insurance information as needed to assist in payment of debt for designated accounts.
• Responds to incoming telephone, mail and email and Epic CRM inquiries from patients, providers and payers regarding outstanding balance.
• Interacts with other departments, insurance companies, medical professionals and patients on daily basis.
• Recognizes issues relating to claims denials and communicates such information in a timely manner to the manager of the billing department
• Maintains familiarity with the Institute fee schedules as well as CPT and ICD-10 coding; keeps up to date on annual changes.
• May be responsible for Claim Printing/Reviewing of printed claim forms for accuracy to ensure claims are paid timely.
• Maintains patient/employee confidentiality in the management of protected information.
• May be responsible for the submission of electronic claim and/or patient statement files depending on designated accounts receivable.
• May post charges or payments as assigned without automatic electronic assistance.
• Facilitate the collections of patient due balances through applicable collections processes.
• May be asked to participate in new staff orientation to familiarize them with procedures and policy updates as deemed necessary.
• May be asked to assist with special projects.
• Participates in the department’s performance improvement activities.
• Maintains patient/employee confidentiality in the management of information.
• Observes the Health Care System’s compliance policies.

QUALIFICATIONS:

• High School Diploma or GED required
• Associates degree in business, accounting or healthcare preferred
• Medical Billing & Coding or Medical Administrative Assistant Certifications preferred
• Minimum of 3-6 months related office experience in a business office

Equal Employment Opportunity/Affirmative Action:

The Institute for Family Health is an Equal Employment Opportunity Employer. This job summary is intended to be brief and may not list all the duties and functions required, however, it does highlight the essential requirements. Nothing outlined in this job summary is to be construed as an express or implied contract of employment.

Please visit www.Institute.org for more information.