Revenue Cycle Specialist I Remote EST

Phoenix Physical Therapy • Cranberry Township, PA

93d

About The Position

The Revenue Cycle Specialist I provides support covering all aspects of insurance billing, claims follow up and collections, including direct contact to the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeal, non-payment, overpayments, and underpayments.

Requirements

• High School Diploma or equivalent; post-secondary education a plus.
• Minimum of 2 years of healthcare related experience in billing and collections or a medical billing certificate.
• Knowledge of physical therapy billing preferred.
• Knowledge with CMS 1500 and UB04 Billing Forms, EOBs, claims, coding, and charges is required.
• Demonstrated knowledge of third-party and insurance companies' operating procedures, regulations, and billing requirements, i.e., Commercial, Medicare, Medicaid, etc.
• Insurance eligibility and benefit verification.
• Ability to read and understand the information provided on EOB's, remittance advices, and other insurance correspondence.
• Excellent verbal and written communication skills.
• Effective customer service skills with the ability to interact with both internal and external customers, i.e., patients, insurance payors, Patient Care Coordinators, and therapists in a professional manner.
• Ability to prioritize work, handling daily and multiple tasks to completion within the time allotted, while working as part of a team within a demanding environment.
• Knowledge of medical terminology and ICD-10 beneficial.
• Proficiency with Microsoft Office tools with a sharp technical aptitude.
• Ability to work independently with minimal supervision.

Responsibilities

• Ensures efficient processing of billing claims, insurance follow up, collection activities and denials.
• Assists in meeting cash collection goals by reviewing, completing, and submitting appropriate documentation based on payer requirements.
• Conducts research and provides updates and status of collection efforts within the RCM system.
• Performs billing, follow-up, and collection functions for third parties, resolving issues that impact or delay claims payment.
• Communicates information and ideas to make system-wide process improvements.
• Updates data regarding changes and modifications in plan benefits and other contract information relevant to the billing or claims follow up and collection process.
• Serves as support staff for various departments and external payers by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the organization.
• Reviews and responds to correspondence and inquiries generated by third party payers.
• Provides medical record copies and other pertinent information to the appropriate sources throughout the billing and collection process.
• Works collaboratively to facilitate the insurance billing and collections process to improve overall cash collection.
• Professionally answers incoming telephone calls from Payers and patients providing answers to questions and concerns about billing statements.
• Returns all unanswered calls within 24 hours of receipt.
• Handles all correspondence within 1 week of receipt.
• Works exception and rejection work queues, reviews EOBs for correct contract payment.
• Supports overall Revenue Cycle processes to achieve established targets and goals, including the completion of special/specific assigned projects or tasks.
• Monitors the status of denials, appeals, and claim errors by using folders/work queues and conducting routine, periodic follow up on previously researched claims items.
• Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to facilitate timely billing and collections.
• Prepares and sends written appeals when necessary with appropriate documentation.
• Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment.
• Maintains awareness of current regulations.
• Initiates practices that support current regulations.
• Performs other duties as assigned or required.

What This Job Offers

• Job Type: Full-time
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED