Revenue Cycle Assistant

ZEPF CENTER•Toledo, OH

11d•Onsite

About The Position

The Revenue Cycle Assistant position provides administrative support to the Billing and Revenue Cycle teams. This position is responsible for proactive management of patient insurance and eligibility, prior authorizations, and assisting with provider credentialing, claims and billing support. Training and guidance are provided.

Requirements

Requires a high level of accuracy, attention to detail, self-directed follow-up, accurate record keeping
Proven ability to learn and apply new knowledge.
Confidentiality in handling all provider, client, and agency information.
The ability to work independently and independently manage timelines, projects and deadlines.
The ability to prioritize and adapt quickly to changing needs and assignments.
Highly proficient in Microsoft office products.
Superior customer service skills; ability to work with all levels of staff.
The ability to develop a robust understanding of health center and behavioral health billing, credentialing, authorization, and service requirements.
High school diploma or equivalent required; associate’s degree in healthcare administration or related field preferred.
2–4 years of experience in healthcare revenue cycle operations, with emphasis on eligibility, authorizations, claims or credentialing.
Working knowledge of insurance plans, payer guidelines, and medical billing and credentialing.
Proficiency with EHR and practice management systems.
Strong attention to detail, organizational skills, and problem-solving ability.
Those eligible to drive company vehicles must have a valid driver's license and be eligible for coverage as defined by the agency commercial insurance carrier. Those who drive personal vehicles in the course of business must be able to provide proof of insurance.

Nice To Haves

associate’s degree in healthcare administration or related field preferred.

Responsibilities

Verify patient insurance eligibility, benefits, and coverage for services rendered.
Keep EHR updated with current and accurate coverage plan information from 270/271 and client insurance card scans.
Ensure necessary reallocations are performed for timely and accurate billing.
Communicate eligibility findings clearly to other members of the Revenue Cycle and clinical teams as needed.
Assist with resolution of eligibility-related claim rejections and denials.
Obtain, track, and document prior authorizations in accordance with payer and regulatory requirements.
Review clinical documentation and coordinate with clinical team to ensure alignment with authorization requests.
Monitor authorization status, follow up with payers and clinical staff as needed to ensure authorizations are in place to cover services provided, and escalate urgent or complex cases.
Maintain accurate records of authorization requests, approvals, and denials within the EHR to support claims submission and audit readiness.
Assist with resolution of prior authorization related claim issues and denials.
Assist with provider credentialing, re-credentialing, and payer enrollment activities.
Assist with maintenance of provider demographic and enrollment data across revenue cycle systems.
Assist with resolution of credentialing-related payment delays or denials.
Work with Billing Systems Manager to ensure claims are reviewed and modified as necessary for accurate and timely billing.
Troubleshoot claim rejections within clearinghouse and EHR related to eligibility, authorization, and credentialing issues.
Collaborate with Billing Systems Manager and Billing team on denials to resolve payer-specific issues.
Identify trends and root causes contributing to preventable denials and recommend process improvements.
Perform other duties as assigned.