Revenue Cycle Specialist

Description

JOB SUMMARY: Responsible for making sure that BBS is reimbursed correctly and in a timely manner from all insurance companies, reviewing and posting office and surgical charges, and responsible for interacting with the patients to collect outstanding balances.

JOB DUTIES & RESPONSIBILITIES TO INCLUDE: · Identifies delinquent accounts, aging period and payment sources by contacting third party payers· Researches insurance credit balances and regularly writes up requests for refunds· Responsible for appealing incorrectly processed claims, and if necessary, making the appropriate adjustment· Responsible for refiling primary paper claims & secondary claims within a timely manner· Assists secretaries and patients with insurance issues and questions· Handles incoming correspondence from insurance companies· Scans documents when necessary, into the practice management system· Negotiates payments with non-contracted insurance payers· Attends specific insurance training seminars/webinars as required· Participates in appeals hearings as requested by specific insurance companies· Maintains privacy, confidentiality, and security of patient, client, staff, and organizational data. 

Requirements

Accounts Receivable:

· Identifies delinquent accounts, aging period and payment sources.

· Processes delinquent unpaid accounts by contacting third party payers

· Researches insurance credit balances and regularly writes up requests for refunds

· Responsible for appealing incorrectly processed claims, and if necessary making the appropriate adjustment

· Files secondary claims within a timely manner

· Assists secretaries and patients with insurance issues and questions

· Responsible for filing primary paper claims

· Handles incoming correspondence from insurance companies

· Scans documents when necessary into the practice management system

· Negotiates payments with non-contracted insurance payers

· Attends specific insurance training seminars/webinars as required

· Participates in appeals hearings as requested by specific insurance companies

· Maintains privacy, confidentiality, and security of patient, client, staff, and organizational data.  

Billing:

· Posts office and ancillary procedure charges to computer system

· Balances charge totals when batch is completed

· Contacts physician’s immediate staff for corrections needed in order to process the charge. If not received in a timely manner follows up with them again staff until all corrected information is received

· Keeps supervisor informed of any recurring problems regarding charge batches

· Monitors surgery schedule in order to pull off any completed surgeries not received that can be posted and sent out to insurance

· Follows up on all holds and make sure that all tickets put in the status of hold are cleared out within 45 days, and if not brings this to the attention of the Revenue Cycle Director

· Makes sure that all tickets that are in a status approved failed due to lacking demographic information are fixed within a timely manor

· Works missing fee ticket report and contacts appropriate personal so that all missing fee tickets can be located 

· Is responsible for making sure that all information is entered on account so that a clean claim will go out

Patient Collections:

· Works with patients to obtain payment for services and provides alternative payment plans to resolve outstanding debt.

· Contacts patients regarding pre-collection of procedure deposits. 

· Answers main business office telephone lines and processes calls

· Accurately updates financial and demographic information into the appropriate system

· Interacts with collection agencies, bankruptcy and deceased patient accounts as required

· Processes patient receipts per BBS standards

· Identify and process patient refunds a needed 

PERFORMANCE REQUIREMENTS:

· Demonstrates acute awareness of insurance company contracts 

· Displays ability to analyze payment denials and compose letters of appeal

· Possess ability and desire for cross training in all areas of the Business Office

· Reports to work regularly without undue tardiness

· Maintains positive attitude and demonstrates the utmost in professionalism

· Dresses appropriately and professionally 

· Works independently, without supervision

· Completes work accurately and in a timely manner

· Maintains effective working relationships with physicians, administration and other staff members

· Demonstrates good communication skills with other staff members as well as patients, insurance companies, outside physician offices, and physicians

· Possesses ability to identify areas of account problems and explain effectively to patients

· Requires flexibility to work occasional evenings or weekends 

· Attends staff meetings and participates in special committees as required

· Other duties and assignments as necessary

· Overtime as required

Education & Experience

· Two years prior experience in a private practice or hospital billing/business office preferred

· Insurance billing experience utilizing CPT, ICD-10 and modifier coding preferred

· High school diploma or G.E.D required