Revenue Cycle Specialist

Job Summary

Review and process claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for assigned clients.

Major Responsibilities/Activities

Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance

Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff

Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues

Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim

Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion

Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs

Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though

Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved

Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness

Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs

Conduct all job tasks, calls, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations

Consistently support and demonstrate the company mission and values

Other Responsibilities/Activities

Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager

Serve as backup to other teams members as required

Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist or Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager

Requirements

Performance Requirements

Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service Level Agreements, A/R Aging, Net Collection Percentages, Average Cash Per Trip, Denials, Rejections, Account Review Aging, and maintaining a 96% audit score monthly.

Required Education, Skills, & Experience

High School Diploma

At least 1-2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience

Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though

Ability to organize, prioritize and multi-task

Ability to learn, understand, and work within specific compliance, client, and payer requirements

Approach all tasks, duties, and interactions with an attitude of continuous improvement

Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods

Willing and able to adapt to changes in work environment, procedures, priorities, and job duties

Ability to function well within a cross-functional team setting and independently

Detail-oriented

Resourceful

Self-starter

Must possess critical thinking/analytical skills

Proficient in Microsoft Office programs

Preferred Education, Skills, & Experience

Strong preference for prior EMS billing and/or denials experience

Proficient in EMS MC billing software

Working Environment/Physical Requirements

General office environment

Frequent typing

Sitting, standing, walking

Use of basic office equipment such as computer, fax, printer, copier, and telephone

*Please note, our hiring process typically lasts 2-4 weeks with three to four interviews total.*