Revenue Cycle Specialist – Full Cycle Management

MAX Surgical Specialty Management • Philadelphia, PA

19h • Onsite

About The Position

Join MAX Surgical Specialty Management, an innovative leader in the healthcare industry, as we embark on an exhilarating journey of growth and expansion! We are seeking a motivated and dynamic individual to join our Revenue Cycle Management Team as a Revenue Cycle Specialist—Full Cycle Management. The Revenue Cycle Specialist—Full Cycle Management is responsible for the execution and management of the revenue cycle process from beginning to end for their assigned offices. As a Revenue Cycle Full Cycle Specialist, you will be an integral part of the RCM team as well as each office you support. This role requires attention to detail as well as flexibility.

Requirements

• High School Diploma required
• 3+ years of hands-on experience in healthcare revenue cycle management, with a proven track record of optimizing processes
• 1 year experience using Dental Software Network (DSN)
• Proficient in all Microsoft Office applications as well as medical office software
• Proven experience in healthcare billing
• Sound knowledge of health insurance providers
• Strong interpersonal and organizational skills
• Excellent customer service skills
• The ability to work in a fast-paced environment

Nice To Haves

• Medical Billing and/or Coding Certification highly preferred

Responsibilities

• Review all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes to ensure clean claims submission to insurance carriers
• Review all charges, coding and prepare for claims for electronic submission
• Work error reports from clearing house
• Resolve billing edits for clean claim submission
• Obtain required attachments for claims submission from various EMR’s
• Verify insurance coverage and eligibility for patients
• Resolve billing discrepancies and claim denials through follow-up with insurance companies
• Maintain clear communication with management about billing and insurance details
• Review and interpret dental EOBs (Explanation of Benefits), including patient deductibles, co-pays, and insurance/third-party correspondence
• Research and navigate insurance policies, benefits, and exclusions to provide accurate information to patients & management team
• Monitor outstanding claims and follow up with insurances to ensure timely payments
• Follow up to all third-party payers and self-pay accounts documenting appropriate information thoroughly on accounts
• Demonstrate a professional image in dealing with the public, patients, clinical offices, and insurance carriers
• File all secondary insurance claims with appropriate EOB’s daily to avoid timely denials
• Review credit-balance accounts on a weekly basis
• Submit corrected claims or appeals to Insurances carriers for both Medical & Dental
• Performs appropriate adjustments, when required
• Gather payor trends and provide feedback to management
• Identify and resolve specific coding issues, providing feedback to management
• Work with internal revenue cycle and administrative teams to identify and manage 3rd party payor denials, overpayment, and underpayment issues
• Contact patients regarding coordination of benefits, insurance payments mailed to patient, and outstanding patient balance
• Post denials within required timeframe accurately into each practice management system
• Analyze and resolve insurance claim denials, including underpayments and rejections
• Track and document all actions taken on denied claims within the billing system
• Communicate with leadership, patients, and insurance representatives to clarify billing discrepancies
• Identify trends and provide feedback to improve claim submission processes and reduce denials
• Communicate with healthcare providers, patients, and insurance representatives to clarify billing discrepancies
• Manage claim denials related to authorization, medical record
• Utilize phone etiquette to communicate effectively with patients regarding their accounts
• Assist patient billing & collections team to answer patient calls during high volume inbound calls periods
• Process credit card payments
• Make outbound self-pay collection calls to patients regarding outstanding balances
• Perform any and all other duties as assigned

Benefits

• Highly competitive salaries & annual performance and compensation reviews
• Competitive health insurance and benefits, including medical, dental, vision, disability, and more
• 401k retirement savings plan that includes employer match
• Generous Paid Time Off, sick leave, and paid holidays
• Advance your career growth with opportunities in the most extensive growing oral surgery practice in the Northeast

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED