Specialist, Revenue Cycle - Onsite

CareSpot•Jacksonville, FL

5d•Onsite

About The Position

Position Summary ?? The Revenue Cycle Specialist will be responsible for the day-to-day operation in the following areas: billing, Claims resolution, A/R follow-up, Credit Balance, EDI Billing, or Posting. Under the direction of the Manager the specialist will be responsible for handling all functions related to the designated area and any other duties assigned by management.??? Duties and Responsibilities ?? Responsible for claim submissions to Urgent Care payors in accordance with all insurance regulations and requirements. Process Urgent Care Payor credit card payments. ? Provide all necessary documentation required by payors to resolve claim issues or denials, including medical records, prior authorizations, audits, etc. ? Analyze and research all denials and over or under payments, with focus on Medicaid/Medicare. ? Ensure all payor correspondence is reviewed and followed up on immediately. ?? Provide exceptional customer service and communication to payors and resolve any accounts receivable requests in a timely and accurate manner. ? Communicate any issues to the Revenue Cycle Director\Management. Validate/Update unbilled Medicaid/Medicare unbilled charges, daily. Act as the liaison between Omega and Centers for Urgent Care, Medicare and Medicaid focused, questions/issues. Other duties and responsibilities as assigned. ? ? Please Note:? The list of responsibilities detailed above is not a comprehensive list, nor is it intended to be a list of all responsibilities and duties of the RCM specialist. ?

Requirements

2+ years of relevant Healthcare billing experience within a healthcare facility or healthcare insurance company.
Deep understanding of medical billing rules and supporting documentation requirements for relevant Healthcare claims and remits.
Knowledge of ICD-10 and HCPC coding, modifiers, and other medical terminology.
Proficient with Microsoft Office, specifically Excel, Outlook, and Word.
High School diploma required.
Ability to pass a Level II background screening and clearance through AHCA (Agency for Healthcare Administration) - https://info.flclearinghouse.com/

Nice To Haves

Medicaid and/or Medicare credentialing experience preferred, not required.
NextGen experience a plus, but not a requirement.

Responsibilities

Responsible for claim submissions to Urgent Care payors in accordance with all insurance regulations and requirements.
Process Urgent Care Payor credit card payments.
Provide all necessary documentation required by payors to resolve claim issues or denials, including medical records, prior authorizations, audits, etc.
Analyze and research all denials and over or under payments, with focus on Medicaid/Medicare.
Ensure all payor correspondence is reviewed and followed up on immediately.
Provide exceptional customer service and communication to payors and resolve any accounts receivable requests in a timely and accurate manner.
Communicate any issues to the Revenue Cycle Director\Management.
Validate/Update unbilled Medicaid/Medicare unbilled charges, daily.
Act as the liaison between Omega and Centers for Urgent Care, Medicare and Medicaid focused, questions/issues.
Other duties and responsibilities as assigned.