Revenue Cycle Specialist

Northeast OB/GYN•San Antonio, TX

38d

About The Position

This role is responsible for maintaining detailed knowledge of revenue cycle functions, working through claim edits, denials, and aging tasks to ensure timely payments from insurance. The specialist will initiate claim submissions, perform account reviews, and identify trends to conduct root cause analysis on unpaid accounts. Additionally, the role involves responding to inquiries from patients and staff, managing work queues, and communicating with payers for claim adjudication.

Requirements

Detailed knowledge of revenue cycle functions.
Ability to work through claim edits, denials, and aging tasks.
Proficiency in working accounts receivable for timely insurance payments.
Skill in initiating claim submissions and performing account reviews.
Ability to identify trends and perform root cause analysis on unpaid accounts.
Experience responding to inquiries and calls from patients or staff members.
Knowledge of regulatory requirements related to revenue cycle.
Experience with insurance eligibility verifications.
Ability to review charges for accuracy, completeness, modifiers, and medical necessity.
Experience managing work queues and following up with third-party payers.
Proficiency in documenting contact with insurance companies.
Experience managing and responding to payer requests for information/medical records.
Skill in communicating with patients about billing inquiries and discrepancies.
Ability to work as part of a team and provide coverage for colleagues.

Responsibilities

Maintains detailed knowledge of revenue cycle functions.
Reviews and completes work log tasks in the system by working through claim edits, denials, and aging tasks; turns in daily productivity reports as required.
Works accounts receivable to ensure timely payments from insurance.
Initiates claim submissions, performs account review, and ensures work is accurate and complete.
Identifies trends, conducts follow-up, and performs root cause analysis on unpaid accounts.
Responds to inquiries and calls from patients or staff members.
Reviews websites, bulletins, and other resources to maintain current knowledge of regulatory requirements and relays information to Manager and team members.
Performs insurance eligibility verifications and updates patient coverage as needed.
Reviews charges for accuracy, completeness, modifiers, and medical necessity; corrects as necessary and submits timely. Corrects and resubmits rejected claims.
Manages work queues for assigned providers; follows up with third-party payers on unpaid or denied claims via portals, phone, chat, email, and appeals as necessary.
Documents contact with insurance companies and others using appropriate designated methods.
Manages and responds to payer requests for information/medical records for claim adjudication.
Communicates with patients about billing inquiries and discrepancies.
Works as part of a cohesive team, providing coverage for other team members as needed.
Performs additional duties as assigned.