Revenue Cycle Specialist III

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Time Type:

Full time

Department:

Patient Accounts

All Locations:

300 Ocean Avenue – Revere

Position Summary:

Revenue Cycle Specialist performs a wide spectrum of billing functions to minimize accounts receivable and enhance collection performance. Utilize electronic medical billing systems as well as in depth advanced knowledge of medical billing and insurance rules and regulations to resolve accounts receivables issues. This position serves as the primary resource on complex issues and specified duties.

• Meet deadlines and productivity standards for Epic work queues, including but not limited to Insurance verification (Epic RTE), Denials (research root cause, identify trends, correct, appeal), Claim Edits (ensure clean claim submission), Transaction history (track claim submission and payor response).

• Work the priority Epic work queues, projects and/or accounts and provide immediate feedback to management.

• Utilize payor websites to research policies and coverage eligibility for use in claim adjudication, trend identification, and application for process improvement.

• Utilize MS Office, with an emphasis on Excel to document, trend, and communicate workflow assignments, trends, and information vital to performance.

• Apply transfers and/or adjustments to invoices as necessary to complete the resolution of each invoice.

• Knowledge of ICD-10, Modifiers,Revenue Codes, HCPCS and CPT codes.

• Coordinate data to complete special billing projects based on contractual obligations and regulatory demands.

• Apply knowledge of insurance rules and regulations to interpret new insurance/HCFA/UB/HIPAA information and report potential impact.

• Work along NeighborHealth Patient Accounts Leadership with various payors as part of the contact group responsible for updates and information required to assist others in the organization.

• Participation in various projects and testing of updates for evaluation and implementation.

• Maintains good interpersonal relationships with stakeholders internal and external to the department.

• Provides feedback to assist NeighborHealth management in developing strategies to improve financial service operations.

EDUCATION: High School Diploma or equivalent.

EXPERIENCE: 

• 3+  years of experience in a medical billing

• 3+ years of Epic PB Resolute experience required

• Demonstrate proficiency with a variety of automations, including but not limited to Epic, Microsoft Word, Excel, Email and electronic data processing skills

• Working knowledge of insurance rules and regulations

• Proficiency in PC software (i.e database)

• Ability to manage multiple tasks/projects simultaneously

SKILLS/ABILITIES:

• Proficiency level understanding of Medical Billing, ICD and CPT coding preferred.

• Strong organizational skills and effective interpersonal skills

• Excellent communication skills (verbal and written)

Benefits:

• Medical, dental, and vision coverage

• Life and disability insurance

• 401(k) retirement plan

• Tuition reimbursement

• Flexible spending and transportation accounts

• Paid holidays, vacations, sick, and personal time

• Generous staff development benefit

• Excellent malpractice coverage

• Pet insurance

• Free parking

• And much more

Pay Range

Starting at $24.00 up to $36.00 depending on experience

EEO & Accommodation Statement:

NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to [email protected] or call 617-568-4480 to let us know the nature of your request

Federal Trade Commission Statement:
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or “apps.” Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.

E-Verify Program Participation Statement:

NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.