Revenue Cycle Management Specialist I

COREPLUS SERVICIOS CLINICOS Y PATOLOGICOS LLC•Carolina, PR

About The Position

The Revenue Cycle Management Specialist is responsible for overseeing and optimizing the financial aspects of a healthcare organization's revenue cycle. They play a crucial role in ensuring that the organization receives proper reimbursement for medical services provided to patients. This involves managing the billing and collections process, resolving any billing issues, and ensuring compliance with relevant regulations and policies.

Requirements

Education: Bachelor's degree in healthcare administration, finance, or a related field. Some positions may require additional certifications in revenue cycle management.
Experience: Previous experience in revenue cycle management, medical billing, or healthcare financial services is preferred.
Knowledge: Proficiency in medical coding systems (e.g., CPT, ICD-10), billing processes, and healthcare regulations (e.g., HIPAA, Medicare, Medicaid).
Analytical Skills: Ability to analyze financial data, identify trends, and make data-driven decisions to optimize revenue cycle performance.
Communication: Strong verbal and written communication skills to interact effectively with patients, insurance companies, and internal staff.
Problem-Solving: Capacity to identify and resolve billing issues and denials in a timely manner.
Attention to Detail: A meticulous approach to ensure accuracy in coding, billing, and financial records.
Technology Proficiency: Familiarity with healthcare management software, electronic health records (EHR), and billing systems.

Responsibilities

Accurately code and submit claims to insurance companies and government payers following industry guidelines and coding standards.
Monitor the status of submitted claims, identify, and resolve claim denials or rejections, and ensure timely resubmission if necessary.
Handle patient billing inquiries, provide explanations of charges, and assist patients with payment arrangements and financial assistance options.
Monitor and analyze accounts receivable, follow up on overdue payments, and implement strategies to reduce outstanding balances.
Ensure compliance with healthcare regulations, privacy laws, and payer requirements throughout the revenue cycle process.
Identify opportunities for revenue enhancement, such as improving coding accuracy and maximizing reimbursements.
Generate and analyze revenue cycle performance reports to track key performance indicators and identify trends or areas for improvement.
Collaborate with various stakeholders, including medical staff, billing departments, and insurance companies, to facilitate smooth revenue cycle operations.