Revenue Cycle Associate

Lexington Medical Center

1d•Onsite

About The Position

This position is responsible for complying with and mastering all Government, Non-Government, and Third Party Payer regulations and contracts. The role involves interpreting these regulations to submit claims for processing and collect patient account balances. The associate will interpret and apply compliance guidelines to maintain billing integrity and report any fraudulent or abusive practices to the appropriate personnel. A key aspect of this role is mastering an understanding of physician billing for various specialty types.

Requirements

High School Diploma or Equivalent
1 Year of experience in healthcare business office or physician office environment
Procedural knowledge of Medical/Medicaid and third party liability billing, reimbursement, and regulatory compliance
Procedural knowledge of account receivable management and understanding of entire revenue cycle

Responsibilities

Responsible for compliance with applicable payer policies, guidelines and regulations.
Frequent contact with payers and insurers to resolve claims and determine coordination of benefits.
Accurately interpret remittance advices, payer bulletins or advisories, fee schedules and other pertinent information.
Responsible for meeting productivity levels as defined in the critical elements specific to the position.
Analyzes and determines appropriate action to account balance to provide thorough and timely follow-up.
Accurately determines when contractual adjustments are needed or to balance bill the patient for services or items that are non-reimbursable per the payer.
Responsible for ensuring payments are posted correctly.
Submitting corrected claims to request adjustments by payers when appropriate.
Research, analyze and resolves denied, rejected or edited claims for applicable payers.
Responsible for accurate and prompt submission of all applicable primary and secondary claims to ensure timely payments and optimize reduction of A/R days.
Includes obtaining all necessary information prior to billing, making corrections to errors, resolving any billing discrepancies, filing corrected claims when necessary, maintaining claim edits and rejections on billing system.
Responsible for following accounts to final insurance payment including identifying appropriate accounts for write off.
Requires daily contact with all payers to resolve claims that have not paid within a reasonable amount of time according to the policy and procedure.
Identifies which charges, if any, are to be written off when specific criteria have not been met.
Responsible for communicating with the physician practice manager or other departments to resolve any claim discrepancies.
Responsible for identifying diagnoses’ or procedures which require supporting documentation and providing documentation to payer as needed.
Responsible for maintaining billing integrity, alerting supervisor of any fraudulent or abusive billing practices, (e.g., duplicate billing, overstating charges, etc.).
Abides by Service Expectations of Lexington Medical Center.
Actively participates in departmental meetings and stays up to date of best practice.
Perform all other duties as assigned by authorized personnel or as required in an emergency (i.e., fire or disaster).

Benefits

Day ONE medical, dental and life insurance benefits
Health care and dependent care flexible spending accounts (FSAs)
403(b) match plan day one
LHI matches dollar for dollar up to 6%
Employer paid life insurance – equal to 1x salary
Employee may elect supplemental life insurance with low cost premiums up to 3x salary
Adoption assistance
Employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
Tuition reimbursement
Student loan forgiveness