Revenue Cycle Coordinator

Job Description

Description:

Revenue Cycle Coordinator

Position Overview:

The Revenue Cycle Specialist (RCS) is responsible for managing the revenue cycle, which is the process of generating, acquiring, and delivering revenue. Key responsibilities include processing and submitting claims to insurance companies and patients, following up on unpaid claims, resolving discrepancies with payers, ensuring timely collection of payments from insurance companies and patients. The Revenue Cycle Specialist is also responsible for submitting and obtaining all necessary documentation to create revenue for insurance companies. RCS is required to understand and interpret payer contracts.

Essential Job Functions: Overall

Meet with Revenue Cycle Supervisor and Director to discuss areas of concern.

Answers questions and provides solutions to Revenue Cycle Management team.

Creates and updates Standard Operating Procedures (SOPs) and Work Aids for both domestic and global revenue cycle teams

Supports Daily and Weekly Communication of Payer, Product and Process Updates to both domestic and global teams

Reviews request from team members for updates to payer / system configuration and submits to the appropriate team for system update

Monitor and report on key performance indicators related to revenue cycle activities, such as claim denial rates, time to payment, and outstanding accounts receivable, to identify areas for improvement.

Work on complex and intricate revenue-related matters.

Supports global team and provides feedback though QA, reviews and huddles.

Monitors work completed by global partners and resolves tasks the global team cannot resolve.

Trains and provides support to domestic and global team members

Submits price table, payer rule, and system configuration updates to designated team.

Provide feedback to Intake team members on processing errors that have taken place.

Essential Job Functions: Insurance Changes

Process and submit insurance changes in a timely manner

Submit updates to insurance selection tools if the insurance change is the result of a risk update that has taken place with the payer

Communicate with patients via appropriate mechanism (text, phone, e-mail, etc) to obtain insurance information or required information to qualify the patient

Essential Job Functions: Cash Application and Refunds

Process and apply insurance and patient cash in a timely manner

Monitor cash that is being received mail from payers.

Determine alternate methods to receive payments from insurance. Submit requests to payers for ERA (Electronic Remittance Advise) and EFT (Electronic Fund Transfer)

Essential Job Functions: Insurance and Patient AR / Denials

Process and submit insurance claims to various payers, ensuring accuracy in coding and billing information to minimize denials and delays.

Review patient accounts to verify correct insurance billing information, update records as necessary, and resolve any discrepancies in patient account balances.

Analyze denied claims to identify denial reasons and perform the necessary follow-up actions including appealing denied claims with appropriate documentation and justification.

Analyze accounts receivable reports and take appropriate action to resolve repetitive denials.

Coordinate with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement.

Discusses areas needing improvement with the authorization and CMN departments as needed and offers solutions.

Engage directly with patients to explain their bills, resolve billing inquiries, and set up payment plans for outstanding balances, ensuring a positive customer service experience.

Engage in written communication and schedule meetings with payers to address aging balances.

Compiles and submits projects to insurance companies.

Meet with Revenue Cycle Supervisor and Director to discuss areas of concern.

Answers questions and provides solutions to RCM team.

Supports auditors responsible for the production/quality of global team members.

Essential Job Functions: Unbilled Revenue

Process and submit authorization and CMN requests to medical groups, plans, and physicians’ offices. Follow-up in a timely manner.

Process eligibility verification and determine payer, benefits, and coverage criteria.

Escalate any unbilled payer requirements for correction in the systemRequirements:

Minimum Qualifications:

Minimum one year of customer service experience

High school diploma or equivalent required

Effective verbal and written skills

Knowledge in all major insurance carrier reimbursement guidelines and eligibility coverage (Medicare, Medi-Cal, Commercial Health Plans)

Able to work in a fast-paced environment, flexible and ability to adapt to changing environment

Strong interpersonal, communication, time management, and organizational skills required

Self-Starter with the ability to work independently

Working knowledge of MS Office

Physical Demands and Working Environment

The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions.

Environment: Standard office setting; tasks are regularly performed without exposure to adverse environmental conditions; frequent interaction with staff and the public. The role requires that you wear a headset, access and work within multiple systems while addressing callers’ concerns in real time.

Physical: Incumbents require sufficient mobility to work in an office setting; stand or sit for prolonged periods of time; operate office equipment including use of a computer keyboard; light lifting, carrying, pushing and pulling; ability to verbally communicate to exchange information.

Vision: See in the normal visual range with or without correction; vision sufficient to read computer screens and printed documents; and to operate assigned equipment.

Hearing: Hear in the normal audio range with or without correction.

NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties to meet the ongoing needs of the organization.

Full-time