Revenue Cycle Specialist

Barrow Brain and Spine•Phoenix, AZ

1d•Onsite

About The Position

The Revenue Cycle Specialist is responsible for ensuring that Barrow Brain and Spine (BBS) is reimbursed correctly and in a timely manner from all insurance companies. This role involves reviewing and posting office and surgical charges, and interacting with patients to collect outstanding balances. The specialist will identify delinquent accounts, research insurance credit balances, and process refund requests. They will also be responsible for appealing incorrectly processed claims, refiling primary and secondary claims, and assisting patients and staff with insurance-related issues. The role requires handling correspondence from insurance companies, scanning documents into the practice management system, and negotiating payments with non-contracted payers. The specialist is expected to attend insurance training seminars/webinars and participate in appeals hearings as requested. Maintaining the privacy, confidentiality, and security of all data is paramount. Additionally, the role includes posting office and ancillary procedure charges, balancing charge totals, and following up with physician's staff for necessary corrections. The specialist will monitor the surgery schedule to post completed surgeries, follow up on all holds to ensure they are cleared within 30 days, and address any approved failed tickets due to missing demographic information. They will also work missing fee ticket reports and ensure all information is entered for clean claims. Patient interaction includes obtaining payment for services, providing alternative payment plans, and contacting patients regarding COB information. The role also involves answering main business office telephone lines, processing calls, updating financial and demographic information, interacting with collection agencies, bankruptcy, and deceased patient accounts, processing patient receipts, and identifying/processing patient refunds.

Requirements

Demonstrates acute awareness of insurance company contracts
Displays ability to analyze payment denials and compose letters of appeal
Possess ability and desire for cross training in all areas of the Business Office
Reports to work regularly without undue tardiness
Maintains positive attitude and demonstrates the utmost in professionalism
Dresses appropriately and professionally
Works independently, without supervision, completes work accurately and in a timely manner
Maintains effective working relationships with physicians, administration and other staff members
Demonstrates good communication skills with other staff members as well as patients, insurance companies, outside physician offices, and physicians
Possesses ability to identify areas of account problems and explain effectively to patients
Attends staff meetings and participates in special committees as required
Other duties and assignments as necessary, overtime as required
High school diploma or G.E.D required

Nice To Haves

Two years prior experience in a private practice or hospital billing/business office preferred
Insurance billing experience utilizing CPT, ICD-10 and modifier coding preferred
Athena One EMR and Centricity experience preferred

Responsibilities

Identifies delinquent accounts, aging period and payment sources by contacting third party payers
Researches insurance credit balances and regularly writes up requests for refunds
Responsible for appealing incorrectly processed claims, and if necessary, making the appropriate adjustment
Responsible for refiling primary paper claims & secondary claims within a timely manner
Assists secretaries and patients with insurance issues and questions
Handles incoming correspondence from insurance companies
Scans documents when necessary, into the practice management system
Negotiates payments with non-contracted insurance payers
Attends specific insurance training seminars/webinars as required
Participates in appeals hearings as requested by specific insurance companies
Maintains privacy, confidentiality, and security of patient, client, staff, and organizational data
Posts office and ancillary procedure charges to computer system
Balances charge totals when batch is completed
Contacts physician’s immediate staff for corrections needed in order to process the charge. If not received in a timely manner follows up with them again staff until all corrected information is received
Keeps supervisor informed of any recurring problems regarding charge batches
Monitors surgery schedule in order to pull off any completed surgeries not received that can be posted and sent out to insurance
Follows up on all holds and make sure that all tickets put in the status of hold are cleared out within 30 days, and if not brings this to the attention of the Revenue Cycle Director
Makes sure that all tickets that are in a status approved failed due to lacking demographic information are fixed within a timely manor
Works missing fee ticket report and contacts appropriate personal so that all missing fee tickets can be located
Is responsible for making sure that all information is entered on account so that a clean claim will go out
Works with patients to obtain payment for services and provides alternative payment plans to resolve outstanding debt
Contacts patients regarding COB information
Answers main business office telephone lines and processes calls
Accurately updates financial and demographic information into the appropriate system
Interacts with collection agencies, bankruptcy and deceased patient accounts as required
Processes patient receipts per BBS standards
Identify and process patient refunds a needed