Revenue Cycle Specialist - Manning - Business Office

El Rio Health • Tucson, AZ

8d • Onsite

About The Position

The Revenue Cycle Specialist, as part of a team, is responsible for performing administrative and fiscal duties, tasks, and assignments at a specialist level in support of the Business Office Department and its varied operations. This role assists in optimizing the department’s workflow and processes using the EPIC Electronic Health Record (EHR) system and requires knowledge of the organization’s policies, procedures, and business operations. The Revenue Cycle Specialist works closely with management and other revenue cycle paraprofessionals to complete recurring administrative revenue cycle duties and tasks, manage cash inflow activities, and support the resolution of billing obstacles. The role serves as a conduit to identify business partner issues, such as customer disputes, and summarizes information for resolution. It involves responding to requests for information and records, supporting the facilitation of billing services and functions, and interfacing with multiple systems, online resources, and software programs. The Revenue Cycle Specialist may work in either a medical or dental receivable assignment at a location assigned by management. The functions and requirements of this position follow standardized procedures and policies, requiring minimal judgment in their execution and will always remain within the defined scope for the position. The Revenue Cycle Specialist works with intermittent supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are presented to the supervisor for resolution.

Requirements

• High School Diploma or General Education Diploma (G.E.D).
• Three (3) years’ experience working in a medical or dental account receivables or claims examination role in a healthcare environment.
• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
• Reliable transportation that can meet any operational reassignments of the organization during the workday.
• If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

Nice To Haves

• Five (5) years’ experience working in medical or dental account receivables or claims examination role in a healthcare environment.
• Coding certification preferred.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

Responsibilities

• Performs administrative, technical, and fiscal duties, tasks, and assignments supporting Business Office operations within established periods; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of quality, efficiency, and accuracy in the employee’s job performance that ensures the highest standards of excellence.
• Maintains at all times patient confidentiality by controlling the information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as accepted confidentiality standards.
• Participates in meetings with third-party payers to resolve contractual discrepancies or payment issues when needed/requested.
• Responsible for creating and completing system tasks related to revenue cycle elements including, but not limited to evaluating accuracy of patient financial information, insurance eligibility, verifying covered services via online and direct communication with health plan representatives and managing appeals and claims follow-up.
• Responsible for communicating observed payment trends, non-payment and/or incorrect payments to the management team.
• Advocates and educates patients and providers regarding billing concerns and responsible for establishing patient payment plans.
• Under supervision, researches, reviews, interprets, and processes healthcare services and claims in order to support accurate patient account and payer balances, applying correct account adjustments based on current CPT, regulatory, and payer specific billing rules.
• Maintains accurate and current information on patient account and payer balances by posting third-party and patient payments, adjustment, or denials.
• Obtains and maintains accurate information on patient financial responsibility by verifying patient insurance coverage and eligibility; obtains proper medical releases as required.
• Supports the continual improvement of the revenue cycle by assisting management and other colleagues on projects; provides feedback on processes and newly implemented changes in order to achieve continued process improvement.
• Responsible for completing system tasks and processing related to revenue cycle elements, such as: Evaluating the accuracy of patient financial information. Managing the resubmission processing of claims.
• Responsible for communicating observed payment trends, non-payment and/or incorrect payments to the management team.
• Completes assigned projects in coordination with management.
• Embraces and supports a professional working environment based upon an understanding and respect for diversity and multi-culture in all its forms; demonstrates sensitivity, acknowledges varied beliefs, attitudes, behaviors, and customs; and encourages communication and appreciation of all forms of diversity.
• Demonstrates an exceptional level of customer service, answering and responding to all incoming calls, emails, and inquiries in a timely and effective manner, responds to requests for support providing general information in response to inquiries; referring technical inquiries or complaints to the appropriate department member for resolution.
• Exemplifies “World Class” customer service experience working to resolve complaints and living the mission, vision, and values of the organization.
• Communicates effectively through written, verbal, and interpersonal skills as applied when interacting with employees, internal/external clients or representatives, or patients, successfully conveying and exchanging information in a positive and effective manner.
• Ensures accurate information is maintained for patient accounts and payer balances by posting third party and patient payments, adjustments/denials, and reclassifying charges to correct payers.
• Demonstrates a higher level of attention to detail, and lower error rate in the employee’s work, ensuring that required and entered information is accurate and payer balances are included in patient accounts and payer accounts by completing data-entry posting and processing requirements.
• Gains and maintains an understanding of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding.
• Gains and maintains a general understanding of applicable Federal, State, and commercial payer requirements, standards, regulations, or laws; as well as all organizational policies and procedures related to healthcare billing and payment processing.
• Attends and participates in conferences, workshops, and other training opportunities related to receivables billing, coding, and corporate compliance standards, or regulations.
• Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.
• Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.

Benefits

• Reasonable accommodations may be made to enable individuals with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices to perform the essential functions of the job.
• El Rio Health does not discriminate based on race, color, religion, sex (including pregnancy, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors.
• It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.
• El Rio Health requires all AZ employees to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. New hires and transfers must submit their fingerprint clearance card or fingerprint receipt before their hire date or transfer date. Level One (1) Non-IVP Fingerprint Clearance card must be received within 30 days after the new employee hire date or transfer date.
• All employees are strongly recommended to obtain and maintain vaccination status (i.e., as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Subject to exemptions and accommodations when required by law. (Policy: Adm-016 & Adm-045).
• All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing.
• Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.
• El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards.
• El Rio Health is an equal opportunity employer.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED