Revenue Cycle Associate

Lexington Medical Center • Columbia, SC

23h

About The Position

The Revenue Cycle Associate works in Patient Financial Services to interpret and apply Government, Non-Government, and third-party payer rules and contracts in order to submit claims, resolve accounts, and collect patient balances. The role requires knowledge of physician billing across specialties and compliance practices that support billing integrity. The associate must report suspected fraudulent or abusive billing practices to a supervisor or other appropriate person.

The position follows claims through final insurance payment, researches and resolves claim issues, ensures accurate payment posting, and follows applicable payer guidelines. It also involves regular communication with payers, insurers, physician practice managers, and other departments. The role is full-time, day shift, with 40 hours indicated.

Requirements

• High school diploma or equivalent.
• At least 1 year of experience in a healthcare business office or physician office environment.
• Procedural knowledge of Medicare/Medicaid and third-party liability billing, reimbursement, and regulatory compliance.
• Procedural knowledge of accounts receivable management and understanding of the entire revenue cycle.
• No required certifications or licensure.
• No substitutable education or experience.

Responsibilities

• Comply with applicable payer policies, guidelines, regulations, and contracts; contact payers and insurers to resolve claims and determine coordination of benefits.
• Interpret remittance advices, payer bulletins and advisories, fee schedules, and other relevant information.
• Meet productivity levels defined for the position.
• Analyze account balances and determine appropriate, timely follow-up, including contractual adjustments or patient billing for non-reimbursable services or items.
• Ensure payments are posted correctly and submit corrected claims to request payer adjustments when appropriate.
• Research, analyze, and resolve denied, rejected, or edited claims.
• Submit accurate and timely primary and secondary claims, obtain necessary information before billing, correct errors and discrepancies, and maintain claim edits and rejections in the billing system.
• Follow accounts through final insurance payment, identify accounts eligible for write-off, and contact payers daily about claims that have not been paid within the applicable timeframe.
• Identify charges to write off when specified criteria have not been met.
• Communicate with physician practice managers and other departments to resolve claim discrepancies.
• Identify diagnoses or procedures requiring supporting documentation and provide documentation to payers as needed.
• Apply knowledge of medical records billing instructions relating to diagnosis codes and DRGs.
• Maintain billing integrity and alert a supervisor to suspected fraudulent or abusive billing practices.
• Follow Lexington Medical Center service expectations, participate in departmental meetings, and stay current with best practices.
• Perform other duties assigned by authorized personnel or required in an emergency.

Benefits

• Medical, dental, and life insurance benefits beginning on day one.
• Health care and dependent care flexible spending accounts (FSAs).
• 403(b) match plan enrollment beginning on day one; employer matches dollar for dollar up to 6%.
• Employer-paid life insurance equal to one times salary.
• Optional supplemental life insurance with low-cost premiums, up to three times salary.
• Adoption assistance.
• Employer-paid short-term and long-term disability coverage for full-time employees after 90 days of eligible employment.
• Tuition reimbursement.
• Student loan forgiveness.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED