Revenue Cycle Specialist- Follow up Primary Care

St. Elizabeth Healthcare•Erlanger, KY

About The Position

The Revenue Cycle Specialist is responsible for patient and insurance follow-up and revenue cycle activities, including responding to patient calls, working accounts receivable reports and insurance explanations of benefits, handling correspondence, refiling unpaid or incorrectly paid claims, and updating patient demographic and profile information. The role also files claims, responds to insurance refund requests, and enters and edits charges. The specialist provides information and resolves issues for patients, family members, and insurance companies; follows up on claim payments; posts payments and adjustments; manages patient statements, collection letters, and payment arrangements; and maintains accurate logs, documentation, and account records. The position reports to the Revenue Cycle Manager and/or Administrator of Revenue Cycle Services. A work-from-home opportunity may be available after training, with equipment provided.

Requirements

High school diploma or GED.
Less than three years of experience in a medical practice, customer service, or revenue cycle department.
Knowledge of medical insurance, managed care plans, and CPT, ICD-9, and ICD-10 codes.
Ability to read and understand explanations of benefits from insurance companies.
Knowledge of FDCPA and bankruptcy.
Ability to perform detailed and thorough work on assigned special projects.

Nice To Haves

CPC certification is required for designated trainer positions and for those involved in coding directly from the chart.

Responsibilities

Provide information and resolve issues for patients, family members, and insurance companies.
Work adjustment, zero-pay, and accounts receivable aging reports and correspondence daily.
Follow up with insurance companies regarding claim payments or non-payment, and refile claims to secondary insurance when needed.
Submit activity logs, audit journals, explanations of benefits, and account follow-up logs daily.
Communicate professionally with payors, patients, family members, physicians, support employees, co-workers, and management.
Answer incoming calls professionally and courteously within three rings and return voicemail messages within one business day.
Update patient demographic and profile information provided by patients, offices, or insurance companies.
Enter financial hardship information and apply correct adjustments in the practice management system and to patient accounts.
Manage NSF postings, letters, follow-up, check tracking, and related account adjustments.
File claims with insurance companies; enter and edit office, hospital, and nursing-home claims.
Post patient, medical-records, and disability payments accurately, with appropriate account documentation and balancing.
Respond to insurance refund requests, analyze potential overpayments, and maintain an accurate refund log for month-end reporting.
Audit statements, make corrections, and process weekly reports.
Send and track patient statements and collection letters; establish payment plans or arrangements.
Work correspondence and C15/C11 reports, refer accounts to collection agencies, and post agency payments while verifying commissions.
Perform claims follow-up and work the Claim Edit (Reg) work queue and errors in Quadax.
Request medical records from offices and note the accounts; coordinate pulling, copying, and mailing explanations of benefits for claim refiles.
Log bad addresses and notify offices; keep track of envelopes.
Perform other duties as assigned.