REVENUE CYCLE SPECIALIST II

GALEN MEDICAL GROUP PC•Hixon, TN

1d•Onsite

About The Position

The Revenue Cycle Specialist II is responsible for overseeing the revenue cycle activities and supporting the Provider Coding Liaison with provider coding education. The Revenue Cycle Specialist II will also assist with coding and auditing functions.

Requirements

Strong knowledge of CPT and ICD coding systems and coding guidelines.
Proficiency in healthcare regulations, including HIPAA and CMS guidelines, and other relevant compliance standards.
Proficient in MS Word, Excel, and other office applications.
Must have the desire and ability to effectively train and educate providers on coding.
Must have expert knowledge in field of practice and perform proficiently in all competent areas.
Must possess the ability to make independent decisions when circumstances warrant such action.
Must be knowledgeable of practices and procedures as well as the laws, regulations, and guidelines governing functions in the clinical healthcare facility.
Must have the ability to implement and interpret the programs, goals, objectives, policies, and procedures of the department.
Maintains confidentiality of all proprietary and/or confidential information.
Must understand and follow company policies and compliance procedures.
Displays integrity and professionalism by adhering to Galen Medical Group's Code of Conduct.
Excellent verbal and written communication skills.
Strong presentation skills.
Ability to work effectively with other team members throughout the organization.
Exceptional attention to detail, analytical skills, and the ability to work independently.
Strong communication and interpersonal skills to interact with medical providers and other healthcare professionals.
Required High school graduate or equivalent
Certification in Medical Coding is required
Two years’ medical billing, coding, A/R collection experience.
Medical experience and terminology required.
Must be computer literate.
Ability to perform mathematical calculations.
Above average spelling skills.
As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patient's needs efficiently.

Nice To Haves

Level 2 -CPC certified professional coder experience preferred.
Level 2 -CPC certified professional coder experience preferred.

Responsibilities

Evaluate the clinical documentation provided by physicians and APPs to determine the appropriateness and completeness of the information.
Review and assess medical claims to identify discrepancies, inaccuracies, and coding errors.
Identify areas where documentation may lack clarity, specificity, or required details for accurate coding.
Review speciality standards to stay current on regulatory changes, payer rules, and industry best practices.
Ensure compliance with relevant healthcare regulations, coding guidelines, and internal policies.
Assist training sessions with medical providers to improve their coding and documentation practices.
Utilize examples from audited claims to illustrate proper coding and documentation techniques.
Collaborate with healthcare professionals to address their questions and concerns, fostering a culture of continuous learning and improvement.
Assist new providers during onboarding by reviewing and assessing coding and EMR macro/template development.
Deliver third party auditor results and coordination training and development based on provider score.
Collaborate with the RCM team to address identified issues and improve the overall documentation and reduce coding related denials.
Collaborate with the HIT team to address coding issues with macros or provider templates.
Coordinates all functions of the external RCM support team to ensure IKS, site, and their assigned tasks are completed in an efficient and timely manner.
Monitors assigned AR to ensure claims are refiled properly and timely.
Works with RCM support team to ensure projects and meetings are productive and complete.
Answer CSR phone calls as needed to address patient questions regarding their account.
Monitor assigned sites to make sure RCM process is flowing smoothly, charges are going out, denials are worked, etc.
Make recommendations for any improvements in workflow, denial management, etc.
Review Waystar rejections weekly for denial trends and notify appropriate dept/staff of issues.
Reviews insurance explanation of benefits for procedures to ensure appropriate reimbursement.
Monitors reimbursement of selected procedures on a continual basis.
Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.