Revenue Cycle Specialist- Collections

St. Elizabeth Healthcare•Erlanger, KY

About The Position

The Revenue Cycle Specialist reports to the Revenue Cycle Manager and/or Administrator of Revenue Cycle Services. The role is primarily responsible for responding to patient calls within one business day and working accounts receivable reports and insurance explanations of benefits. Duties also include handling correspondence, refiling unpaid or incorrectly paid claims, maintaining accurate patient demographic and profile information, filing claims with insurance companies, responding to refund requests, and entering and editing charges. The specialist supports patient and insurance account follow-up, payment posting, statement and collection-letter processing, payment arrangements, and coordination of claim refiles and medical-record requests. The position also involves documenting and balancing transactions, maintaining logs, reviewing reports, and working designated claim and error queues.

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 positions involving coding directly from the chart.

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 regarding claim payments or non-payments.
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 with payors, patients and family members, physicians, support employees, coworkers, 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 based on information from 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 account adjustments.
File claims with various insurance companies and enter and edit office, hospital, and nursing-home claims.
Post patient, medical-records, and disability payments to appropriate accounts with accurate documentation and balancing.
Respond promptly to insurance-company refund requests, 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; 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 send medical-record requests to offices, noting the 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 and perform other duties as assigned.