Revenue Specialist Lead

DAP Health•Palm Springs, CA

4d•$27 - $30•Remote

About The Position

At DAP Health, we are committed to transforming lives and advancing health equity for all. As a leading nonprofit health care provider, we deliver compassionate, high-quality care to the diverse communities of the Coachella Valley and San Diego County. Our comprehensive services range from primary care to mental health, wellness programs, and beyond, with a focus on those who are most vulnerable. Joining our team means becoming part of a passionate, innovative organization dedicated to making a meaningful impact in the lives of those we serve. If you're looking for a dynamic and purpose-driven environment, we invite you to explore the opportunity to contribute to our mission. Job Summary: Under the direction of the Billing Revenue Cycle Manager (BRCM), the Revenue Specialist Lead plays an important role in the Revenue Cycle process of DAP Health. This role includes overseeing the Revenue Specialists who are responsible for verification of patient insurance coverage with insurance companies prior to the patients’ appointments (new and existing patients). The role also includes oversight of staff ensuring authorizations (as needed) are received prior to the appointment date, and communicating the authorized procedures to clinical staff. This position oversight of resources to patients, providing them with information regarding their insurance coverage, working with patients to explain what their policy does and does not cover, and arranging for different financing options when necessary. The position includes supervision of revenue specialists discussing out-of-pocket, prior balance and current copay amounts with patients in advance of their appointments.

Requirements

Knowledge of EHR functionality.
Knowledge of California Medicaid, Medicare, and Commercial insurance verification process for primary care, chiropractic and behavioral health services.
Knowledge of Medical Terminology and familiar with insurance billing procedures.
Working knowledge/familiarity with computers and electronic clinical record keeping.
Ability to: Work with accurately and with minimal supervision.
Prioritize workload.
Use sound judgment to field inquiries concerning administrative, clinical and operational concerns.
Deal professionally with patients, families, staff and facility visitors.
Understand and maintain confidentiality in accordance with DAP Health policies.
Ensure data and research are completed in a timely and procedurally correct manner.
Ability and willingness to work with diverse populations.
Requires a flexible schedule including working some evenings and weekends on an emergency basis.
Minimum of three (3) years of related experience; insurance verification, third party insurance billing and patient facing service.
Minimum of one (1) year of prior experience with authorizations in an outpatient medical clinic setting.

Nice To Haves

Knowledge of CPT, HCPCS and ICD-10 a plus.
Experience in a medical outpatient ambulatory office setting, preferred.
Bilingual - English/Spanish, preferred.

Responsibilities

Supervises medical, chiropractic, and behavioral health coverages in advance of appointments.
Monitors that revenue specialists are entering the Electronic Health Record (EHR) insurance plan coverage with appropriate effective and termination dates.
Provides oversight that verifications and discussion of prior balances, co-pays and patient cost shares with patients in advance of appointments.
Ensures revenue specialists are notifying patients of lapses in coverage or coverage issues prior to appointments.
Reviews that documents and logs of expected patient payments are maintained in EHR for Patient Services Representatives prior to patient check-in.
Monitor that the revenue specialists are reviewing that authorized services (coding) accuracy.
Ensures that revenue specialists are maintaining that authorizations are complete and accurate prior to the patient’s visit.
Manage the communication of co-payments and authorized services to clinicians, the front desk and the authorization department.
Verify that scanned documents are being uploaded by revenue specialists as needed into EHR or DAP Health files.
Oversees that maintenance of insurance websites for DAP Health eligibility.
Ensure that revenue specialists are providing assistance to patients with insurance coverage questions.
Responsible for Greenway Follow up requests related to eligibility verification, insurance plan mismatches, and others.
Work closely with Revenue Cycle Coordinator Lead, Coding Supervisor and Clinic Operations staff to resolve in trending errors in eligibility or authorizations.
Accesses patient-protected health information as required.
Ensure team members are meeting established performance and productivity benchmarks
Complete all PTO requests and submission of related documents, including electronic timesheets to the Payroll department as required
Performs other duties as assigned.