Revenue Cycle Specialist I (Remote)

• Prepares and submits clean claims to various insurance companies either electronically or by paper with required documentation as needed.
• Rebills underpayments, appeals denials and turns them into payments, ensures accurate reimbursement from insurance and government payors on all claims. Audits accounts for proper payments, coding, balances, adjustments, etc. using appropriate reports and work queues
• Responsible for posting charges for hospital and/or physician services. Posts payments for patient payment and insurance payments. Prepares, reviews and sends patient statements.
• Follows up on outstanding insurance payor claims and charges in follow-up work queues and on various reports by contacting insurance carriers and patients for status including processing correspondence.
• Performs in depth audits on accounts to ensure proper collections. Ensures accuracy of insurance claims before billing. Identifies accounts that can be written off to bad debt.
• Prepare and process request for refunds with necessary documentation and submit to supervisor for approval.
• Responsible for reviewing and interpreting patient accounts as applicable. Reviews patient bills for accuracy and completeness and obtain any missing information. Makes corrections or adjustments on accounts as necessary. Reviews insurance reimbursement accuracy and appeal if necessary. Update patients file records accordingly.
• Assists with incoming calls, tasks and inquiries. Maintains patient confidentiality at all times. Other duties or special projects assigned.
• Performs general office clerical work including, but not limited to, copying files, entering data and answering phones. Routes communications to appropriate personnel as needed.
• Submits monthly claims billing; follow-up, re-billing, secondary billing and correction billing of claims.
• Performs various collection actions, including contacting insurance carriers, confirming claim status using payer web portals, correcting denial errors, and submitting corrected claims to third party payers.
• Ability to review, interpret and understand government, state, commercial and managed care contracts against EOB’s with third-party payers to ensure appropriate reimbursement.
• Intermediate computer skills including the use of spreadsheet programs and word processing programs.
• Resolve account aging balances; perform insurance verifications when necessary, referrals and authorization. Ensures aging balances are kept within revenue cycle department days in A/R standards. Maintains and updates the unbilled report.
• Emergency duty may be required of the incumbent that includes working in Red Cross shelters or to perform other emergency duties including, but not limited to, responses to threats or disasters, man- made or natural. Additionally, incumbents are required to perform emergency response and management duties for Palm Beach County as required.
• Performs various collection actions, including contacting patients by phone, correcting and resubmitting claim to third party payers.
• Works effectively with the team to determine & communicate correct billings on the account. Participates in educational activities and attends monthly staff meetings.
• Establish and maintain strong relationships with providers, clients, patients and fellow staff. Maintain good communication link with each patient’s home-clinic personnel. Identifies and resolves patient billing complaints. Answers questions from patients, clerical staff and insurance companies.
• Coordinates with other departments for corrections on the unbilled report in a timely manner. Effectively works with assigned insurance carrier(s) to resolve billing issues.

Education:

• High School Diploma or GED required. Associate’s Degree preferred.

Experience:

• Minimum two (2) years of experience in a hospital, physicians office or other healthcare setting required.
• Claim Edits and Denials management experience required. Epic revenue cycle application experience preferred

Certification:

• Must complete CRCR within one year of hire.