Revenue Cycle Specialist- Collections

SEP Summit Medical Group•Erlanger, KY

About The Position

The Revenue Cycle Specialist- Collections reports to the Revenue Cycle Manager and/or Administrator of Revenue Cycle Services. The role handles patient and insurance-company inquiries, accounts receivable work, claim filing and follow-up, payment and adjustment processing, correspondence, refunds, patient account updates, and collection-related activities. Patients’ phone calls must be answered or returned within one business day, with incoming calls answered within three rings. A work-from-home opportunity is available after training, and equipment is provided. The specialist works daily with adjustment, zero-pay, aging, correspondence, and claim-edit reports; follows up on unpaid or incorrectly paid claims; updates patient demographic and profile information; and maintains accurate account documentation and logs. The position also processes statements, collection letters, payment arrangements, medical-record requests, and other revenue-cycle tasks as assigned.

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.

Nice To Haves

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

Responsibilities

Provide information and resolve issues raised by patients, family members, and insurance companies.
Work adjustment, zero-pay, accounts-receivable aging reports, and correspondence daily.
Follow up with insurance companies regarding claim payments or non-payment and perform claims follow-up.
Refile claims to secondary insurance when claims have not been received or processed, and file claims with various insurance companies.
Submit activity logs, audit journals, EOBs, and account follow-up logs daily.
Communicate professionally 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 provided 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 necessary patient-account adjustments.
Edit and enter office, hospital, and nursing-home claims.
Post patient, medical-record, and disability payments; ensure payments are applied to the appropriate accounts with accurate documentation and balancing.
Respond to insurance-company refund requests in a timely manner, analyze potential overpayments, and maintain an accurate refund log for month-end reporting.
Audit statements, make appropriate corrections, and process weekly reports.
Send and track patient statements and collection letters, and set up payment plans or arrangements.
Work correspondence and C15/C11 reports.
Refer accounts to collection agencies and post agency payments while verifying commissions.
Send medical-record requests to offices and note the accounts.
Coordinate pulling, copying, and mailing EOBs for primary and secondary claim refiles.
Log bad addresses and notify the offices.
Work the Claim Edit (Reg) WQ and errors in Quadax.
Keep track of envelopes.
Perform other duties as assigned.