Revenue Cycle Representative

Ohio State University Physicians, Inc.•Columbus, OH

1d•Onsite

About The Position

The Revenue Cycle Representative uses knowledge of invoices, claims, insurance billing, collections and medical terminology in order to complete multiple tasks related to insurance billing. Acts as a liaison between the physician, insurance companies and third parties by processing and verifying invoices, ensuring payment of claims and reviewing insurance reimbursements. Responsible for the tracking of claims throughout the Revenue Cycle and specifically the billing process to identify problem areas and to determine a course of action in resolving aging claims. Follows all governmental regulations as well as policies and procedures as outlined by the OSUP.

Requirements

High School diploma or equivalent with two or more years of medical billing experience; or equivalent combination of education and experience.
Knowledge of insurance carrier payment policies, practices and amounts.
Evidence of organizational and problem-solving skills, and ability to manage multiple priorities.
Ability to effectively communicate both verbally and in writing.
May be required to work under time pressures or demanding requests from various staff members and departments.
Must be able to interact and communicate with individuals at all levels of the organization.

Nice To Haves

Experience with EPIC, Clearinghouse Vendors and Imaging software systems

Responsibilities

Reviews, verifies, obtains and corrects patient demographics and insurance information, medical diagnosis, laboratory and other diagnostic services information, hospital service, applicable dates, required authorizations and certifications, signatures, and other information related to preparation and processing of insurance bills, and eligibility of coverage.
Provides problem resolution on payer 277 rejections and denials and follow-up on issues as needed.
Coordinates and analyzes EOB’s for denials and irregularities, institutes appropriate actions, and reprocesses claims in accordance with Company policy.
Investigates and resolves unpaid claims timely to accurately maximize reimbursement.
Research and resolves missing or conflicting patient information; requests completion of additional forms or information for denied claims or special processing requirements.
Updates work queue and invoices for collection activity according to Department guidelines.
Accurately reconciles accounts; adjusts balances to reflect denials, adjustments, payments and other modifications to balances.
Responsible for identifying trends which impact revenue, communicates identified issues and trends to management. Participates in analysis and solutions to reduce and resolve denials.
Responsible for the follow up on A/R research projects; review status of accounts, action taken, and further course of action if warranted; provides updates to manager regarding status of A/R projects.
Provides problem resolution on denials and follow-up issues as needed.
Attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with co-workers and supervisors, and politeness to customers, vendors, and patients.
Other duties or special projects as assigned.