Revenue Cycle Representative

PCC Community Wellness Center•Oak Park, IL

1d•$21 - $23•Onsite

About The Position

Responsible for performing revenue cycle functions for all medical and/or dental claims for PCC Community Wellness Center, to ensure accurate, timely claim follow up for aged accounts. The Revenue Cycle Rep works collaboratively with Providers, Care Coordinators, Operations, and Revenue Cycle leadership to eliminate department bottlenecks and waist while increasing cash flow and promoting revenue growth.

Requirements

2+ years experience in revenue cycle with strong focus on CMS 1500 insurance claims and accounts receivable management required
Ability to pivot and accept change to meet the needs of the department and/or organization
Ability to follow-through, assume responsibility and use good judgment
Ability to communicate effectively and diplomatically with patients, external insurance and contracting entities and facility personnel both orally and in writing
Ability to understand and follow verbal and written communication
PC, email, facsimile machine, computerized voice mail system, and common office machines.
Windows, MS Office (Word, Excel, PowerPoint), Medical/Dental RCM Software (Athena)

Nice To Haves

Athena EHR experience highly preferred
Previous FQHC/340B experience highly preferred
Previous Availity clearinghouse experience preferred
2+ years previous experience with local state Medicaid/Managed Care plans
Cerner EHR experience a plus
2+ years previous experience with commercial payers and EOB interpretation
Self-motivated and directed with the ability to recognize workflow disruptions ahead of occurrences
Organized and able to manage competing priorities with tight deadlines
Detail oriented with the ability to work with minimal supervision
Willingness to be part of a team-unit and cooperate in the accomplishment of departmental goals and objectives
Maintain professionalism while navigating challenging interactions

Responsibilities

Continually monitor claim volume and aging. Actively follow up on aged pending claims that require resolution or next action for payment for assigned facilities
Review, resolve and release claims within 48 hours of claim creation date for assigned facilities
Review and resolve 100 claims daily (minimum); yielding reimbursement daily for assigned facilities
Resolve state funded claims prior to 180 days outstanding, perform A/R functions on older dates of service with sense of urgency for assigned facilities
Resolve federal funded claims prior to 365 days outstanding, perform A/R functions on older dates of service with sense of urgency for assigned facilities
Resolve commercial funded claims prior to 90 days outstanding, perform A/R functions on older states of service with a sense of urgency for assigned facilities
Initiates write off requests for claims for timely monthly processing for assigned facilities
Monitor global transaction report to eliminate incorrect claims adjustments, promoting accurate and timely claim submission for reimbursement for assigned facilities
Maintains DSO of <40 days for all assigned facilities
Track EHR third-party billing issues/concerns as they are found to improve billing department bottlenecks and efficiencies using designated tracker
Track and monitor provider and site credentialing discrepancies, update designated tracker as needed
Perform timely contractual transactions to ensure accurate financial reporting
Adherence to all local, state and federal billing guidelines for medical, dental and 340B services provided
Adherence to all local, state, and federal billing guidelines for behavioral health and telemedicine services provided
Collaborate with PCR site staff to promote patient data accuracy, maintaining a minimum clean claim submission rate of 95% month over month
Collaborate with department peers communicating trends and billing errors to promote clean claim submissions for timely reimbursement
Accurately submits claim resubmissions through EHR for timely reimbursement; engages EHR for large batch resubmission when supported
Under the guidance of department Certified Coder, ensure maximized reimbursement of rendered services through proper claim coding and physician charting
Partner with Enrollment Specialist for pending Medicaid enrollment cases to ensure timely update of EHR medical profile and claim submission
Operations and Care Coordination Teams to obtain authorizations, consent forms and supporting medical records documents as needed for timely claim processing and maximum reimbursement
Track and reports outstanding documentation needed to direct supervisor, during 1:1 weekly meetings
Perform audits on denied/rejected claims to understand and execute actions based on findings
Ensure all informational coding and billed services align with clinical documentation for claim processing
Follow through of internal and external inquiries based on assigned workload, within 24 hours
Work with payors through active portals, telephone, fax and in-person appointments to ensure timely follow through of claim processing needs
Complies with established policies and procedures, objectives, HIPAA, safety and environmental standards
Remain abreast on FQHC/ 340B/ inpatient and dental industry changes, proactive with notifying billing department leaders of any changes
Effectively train new hires and counterparts as needed
Accomplish projects as a team member or individual as assigned
Perform other duties as may be assigned by department leadership and/or executive leadership