Revenue Cycle Representative

Ohio State University Physicians•Columbus, OH

11d•$18 - $27

About The Position

The Revenue Cycle Representative uses knowledge of invoices, claims, insurance billing, collections, and medical terminology to perform tasks related to insurance billing. The role serves as a liaison between physicians, insurance companies, and third parties by processing and verifying invoices, ensuring claims are paid, and reviewing insurance reimbursements. The representative tracks claims throughout the revenue cycle, particularly the billing process, to identify problem areas and determine appropriate actions to resolve aging claims. The role follows applicable governmental regulations and OSUP policies and procedures. Denials and appeals experience is required.

Requirements

Denials and appeals experience.
High school diploma or equivalent and two or more years of medical billing experience, or an equivalent combination of education and experience.
Knowledge of insurance carrier payment policies, practices, and amounts.
Organizational and problem-solving skills and the ability to manage multiple priorities.
Effective verbal and written communication skills.
Ability to work under time pressures or respond to demanding requests from staff members and departments.
Ability to interact and communicate with individuals at all levels of the organization.

Nice To Haves

Experience with EPIC.
Experience with clearinghouse vendors.
Experience with imaging software systems.

Responsibilities

Review, verify, obtain, and correct patient demographics and insurance information, medical diagnoses, laboratory and other diagnostic services information, hospital services, applicable dates, required authorizations and certifications, signatures, and other information needed to prepare and process insurance bills and determine coverage eligibility.
Resolve payer 277 rejections and denials and follow up on related issues as needed.
Coordinate and analyze EOBs for denials and irregularities, take appropriate action, and reprocess claims in accordance with company policy.
Investigate and resolve unpaid claims promptly to maximize reimbursement accurately.
Research and resolve missing or conflicting patient information; request additional forms or information for denied claims or special processing requirements.
Update work queues and invoices for collection activity according to department guidelines.
Reconcile accounts accurately and adjust balances to reflect denials, adjustments, payments, and other modifications.
Identify trends that impact revenue, communicate issues and trends to management, and participate in analyzing and developing solutions to reduce and resolve denials.
Follow up on accounts receivable research projects, review account status and actions taken, determine further action when warranted, and update the manager on project status.
Maintain attendance, punctuality, professionalism, attention to detail, cooperation with coworkers and supervisors, and courtesy toward customers, vendors, and patients.
Perform other duties or special projects as assigned.