Revenue Cycle Specialist- Follow up Primary Care

SEP Summit Medical Group•Erlanger, KY

About The Position

The Revenue Cycle Specialist- Follow up Primary Care reports to the Revenue Cycle Manager and/or Administrator of Revenue Cycle Services. The role primarily involves responding to patient phone calls within one business day, working accounts receivable reports and insurance explanations of benefits, processing correspondence, refiling unpaid or incorrectly paid claims, and updating or correcting patient demographic and profile information. The specialist also files claims with insurance companies, analyzes and responds to refund requests, and enters and edits charges and claims. This position supports revenue cycle operations through patient and insurer communications, payment and adjustment processing, account follow-up, statement and collection-letter processing, payment arrangements, claims follow-up, and related documentation and reporting. A work-from-home opportunity is 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 special projects as assigned.

Responsibilities

Provide information and resolve issues for patients, family members, and insurance companies.
Work Adjustment, Zero Pay, and A/R aging reports and correspondence daily.
Follow up with insurance companies about payment or non-payment of claims.
Refile claims to secondary insurance when claims have not been received or processed.
Submit activity logs, audit journals, EOBs, and Account Follow-Up Logs daily.
Communicate professionally and effectively with payors, patients and family members, physicians, support employees, coworkers, and management.
Answer incoming calls within three rings and return voicemail messages within one business day.
Update patient demographic and profile information supplied by patients, offices, or insurance companies.
Enter Financial Hardship information and apply appropriate adjustments in the Practice Management system and to patient accounts.
Handle NSF postings, letters, follow-up, check tracking, and related patient account adjustments.
File claims with various insurance companies, and enter and edit claims, including office, hospital, and nursing-home claims.
Post patient, medical-records, and disability payments to appropriate accounts with accurate documentation and balancing.
Respond to insurance-company refund requests in a timely manner, analyze potential overpayments to determine whether refunds are due, and maintain refund logs for month-end reporting.
Audit statements, make appropriate corrections, and process weekly reports.
Send and track patient statements and collection letters.
Set up payment plans or other payment arrangements.
Work correspondence and C15/C11 reports.
Refer accounts to collection agencies and post agency payments while verifying commissions.
Perform claims follow-up.
Send medical-record requests to offices and note them on accounts.
Coordinate pulling, copying, and mailing EOBs for primary and secondary claim refiles.
Log bad addresses and notify offices.
Work the Claim Edit (Reg) WQ and errors in Quadax.
Keep track of envelopes.
Perform other duties as assigned.