The Revenue Cycle Specialist will work with the Inpatient, Physician and specialty billing team to follow-up on all claims, variances and denials in a hospitals accounts receivables (AR). Implements appropriate billing and collection procedures, ensuring that the inpatient and outpatient accounts receivable system records are kept in accordance with established procedures. Performs the inpatient and outpatient billing, and collections operations. Implements controls to ensure appropriate submission, billing, and payment cycles. Reinforces procedures for follow-up on third-party approvals, billing, and collection on overdue accounts. Exceeds NPSR goals on a monthly/quarterly and annual basis. Answers all inquiries from patients or responsible parties regarding their accounts. Performs all other duties assigned by the Director, Manager, Supervisor and/or Team Lead.
- Follow-up with payers to ensure timely resolution of all outstanding claims, via payer portals, phone, email, fax, or customer EMR and claims adjudication systems.
- Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
- Detailed knowledge of Government and Managed Care reimbursement methodologies
- Perform payment variance analysis to identify trends in underpaid claims
- Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.
- Identify and report underpayments and denial trends
- Initiate appeals when necessary
- Basic knowledge of healthcare claims processing including ICD-10, CPT, and HCPC codes, as well as UB-04
- Ability to analyze, identify and resolve issues causing payer payment delays
- Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
- Maintain confidentiality at all times
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
- Report any security or HIPAA violations or concerns to the HIPAA Officers in a timely fashion
The incumbent performs duties in accordance with performance standards set forth by TCG and the customer. The incumbent may have access to highly confidential customer, patient, employee, and TCG proprietary information, and must handle and protect the information in accordance with institutional and system policies, HIPAA requirements, and with the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, and other security risks to the organization. The incumbent is accountable for employee safety and will attend safety and loss-control training, engage in injury prevention, perform accident and injury investigations including conducting root cause analysis, and assist in returning employees to regular duty. The incumbent is responsible for participating in and completing all patient safety initiatives appropriate to the position and conducts all job responsibilities according to the Mission and Values of TCG and the customer.
Education: HS degree required.
Healthcare Experience: (3) year minimum experience in Hospital Medical AR follow-up, and AR Collection in Hospital setting.
Systems Experience: Epic, Cerner, Meditech, Relay, Change Health, Greenway, CPSI, Allscripts system.
Certification: EPIC- HB and PB, Allscripts, and/or CPSI, HFMA- (CRCR)- Certified Revenue Cycle Representative
Other: Ability to work well individually and in a team environment. Proficiency with MS Office. Effective communication skills/oral and written. Strong organizational skills. Strong critical analysis and problem solving.
Salary: $17.50 to 28.00 per hour (depending on experience, certification and payer)
PTO: 120 Hours PTO (80 Hours vacation and 40 Hours sick on an accrual schedule)
- Accrual begins immediately; however, you can’t use it during the first 60 days
- Health Insurance- Medical, Dental and Vision (TCG pays portion)
- Insurance available 30 days from start date
- 401k Plan (TCG matches up to 4% of contribution)
- Flexible Spending Accounts
- Insurance: Life, Personal Accident, Short/Long- Term Disability (voluntary)
- Health and Wellness Benefits- Free Onsite Gym
- Insperity Marketplace Discounts