Revenue Cycle Coordinator

Columbia Basin Health Association•Othello, WA

44d

About The Position

Responsible for developing and maintaining training programs for staff, specific to the Revenue Cycle within Organizational policies for continuous improvement of revenue recovery. Responsible for assisting the Credentialing Coordinator in insurance contracting, provider enrollment and credentialing for all CBHA licensed providers.

Requirements

Demonstrates a high degree of organization and planning skills
Demonstrates ability to use independent judgment to manage and impart confidential information
Possesses skills in examining and re-engineering operations and procedures.
Ability to develop and implement new strategies and procedures
Ability to effectively communicate with and train, Patient Services Representatives, physicians, management and staff
Possesses general work-related skills at a higher level than completion of high school, including written and verbal communications skills, computational and computer skills, and mathematical knowledge frequently acquired through completion of a "business school (non BA/BS)" or "associates degree" type program
Minimum of five (5) years’ experience in medical office/billing services
Possesses knowledge of organization structure, workflow and operating procedures within a Community Health Center billing environment
Ability to prepare basic correspondence and simple reports in Microsoft Word
Ability to prepare basic Microsoft Excel tables and simple displays of information
Ability to prepare and interpret financial and statistical reports
Ability to create basic presentations in Microsoft PowerPoint

Responsibilities

Responsible for training staff
Collaborates closely with the Billing Supervisor and claims management team to identify training needs
Assesses and identifies training needs specific to practice-site operations, specifically those that have an impact on revenue cycle
Administers group and one-on-one training for staff, managers and clinicians employed by the Organization monthly
Coordinates changes in insurance regulation, providing in-service to Billers and Patient Financial Service Representatives.
Attends monthly department meeting for Billing, Coding and Patient Service Representatives.
Responsible for Reimbursement Recovery support
Investigates disallowed codes for reimbursement opportunity, as needed
Assesses A/R rejections and denials, negative payer trends, and provide feedback to management for appropriate action, including training agenda material monthly
Corresponds with third party payers who provide information necessary to assist in determining most appropriate reimbursement levels, as needed
Responsible to assist Billing department to support managing denial claims workflow as directed
Researches denial claims received from payers weekly
Follows-up with customers to ensure maximum payments are made
Reviews outstanding insurance claims within designated alpha discipline or payer monthly
Responsible to assist Billing department to support processing of payments to/from third- party vendors daily as directed
Researches and resolves claim, payment and capitation issues
Reviews claim payments reports
Audits claim payment reports for accuracy and compliance
Monitors charges and verifies correct payment of claims and capitation of deductions
Responsible for assisting with provider enrollment, insurance credentialing and contracting.
Utilizes credentialing software to maintain current and accurate data for all providers
Completes provider credentialing and re-credentialing applications with health insurance companies; monitors applications and follows-up as needed
Maintains knowledge of current health plan and agency requirements for credentialing providers
Ensures practice addresses are current with health plans, agencies and other entities
Processes applications for appointment and reappointment of privileges in compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state) as well as delegated contracts
Audits health plan directories for current and accurate provider information
Performs coding functions as appropriate, including assisting with coding backlogs as
Participates in the development and maintenance of Organizational policies and procedures related to but not limited to operations of the practice management system
Maintains appropriate level of knowledge of practice management software by continuous vendor training and third party education
Develops and maintains specific training materials associated with training programs for the practice management software
Promotes a positive work culture and upholds clinic policies and procedures, including the WE CARE standards of Behavior
Must uphold confidentiality at all times in regards to CBHA activities, reports, financials, patient health information and other proprietary information specific to CBHA
Other duties as assigned