JOB SUMMARY:The Revenue Cycle Associate is responsible for supporting the Accounts Receivable team with a focus on one of the following groupings:
Billing Operations: ensuring the clean submission and processing of Stamford Health Medical Group's (SHMG) claims (once generated in the practice management system); serving as a liaison between SHMG and the clearinghouse; and reconciling non-coding related claim edits
Aging Resolution: researching, resolving, and/or resubmitting those agings without responses from payers, given specific timeframesMAJOR ACCOUNTABILITIES/CRITICAL RESPONSIBILITIES:Billing Operations Focus:
Attends to non-coding related claim edits and resolve errors and billing issues.
Serves as a liaison between SHMG and the clearinghouse and provides expertise related to the claim submission.
Transmits data files and maintains associated control logs and reports for:
Daily claims and returned clearing-house edits and payer edits
Weekly patient letters
Supports the paper claims process: queuing claims for printing, printing claims; separating, sorting, and checking balances; addressing envelopes; and mailing printed claims
Supports the secondary billing function by locating and copying Explanation of Benefits (EOB) forms, ensuring that patient confidentiality is maintained by concealing non-relevant claims.
Provides feedback and communicates with providers and clinic staff to obtain incomplete or missing information needed to process clean claims. Aging Resolution Focus:
Researches aging receivables with the appropriate payer organizations.
Maintains correspondence with payers regarding unresolved balances and keeps a related log.
Collaborates with the Cash Applications team to ensure that aging receivables that have since denied or paid are memorialized, accurately, in the patient management system.
Makes updates in the practice management system as necessary.
Understands and interprets insurance Explanations of Benefits (EOBs).
Resubmits claim forms as appropriate.
Professionally responds to inquiries related to aging receivables from staff and payers in a timely manner.
Utilizes available resources to identify reasons for payment discrepancies.Relevant to Each Focus:
Accurately documents patient accounts of all actions taken.
Establishes and maintains a professional relationship with all SHMG staff in order to resolve problems and increase knowledge of account management.
Maintains standards set by management.
Apprises management of concerns as appropriate.
Informs management, as appropriate, regarding backlogs and time available for additional tasks.
As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.
Completes additional projects and duties as assigned.
Associate's degree or medical billing certification preferred.
At least 2 years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.
At least 2 years of experience in working with a medical office/hospital accounts receivable system.
Working knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.
Basic computer skills, including Microsoft Windows programs.
Moderate to advanced keyboard skills with high accuracy rate.
Ability to communicate effectively in written and spoken English.
Demonstrates effective communication and interpersonal skills with a diverse population.
Ability to organize and prioritize workload to manage multiple tasks and meet deadlines.
The ability to work with individuals at all organizational levels, particularly peers, team members, other departments, patients, and the community is required
The Stamford Hospital