Revenue Cycle Coordinator IV

Opening

Full Time 40 hours Range URCA 206 Patient Financial Services

Schedule

7:30 AM-4 PM

Responsibilities

Location

Rochester Tech Park (RTP), Gates, NY - Remote options available after in-person training. Occasional onsite meetings / work at RTP are required. Remote location must be within 2 hours of RTP and within New York State.

Position Summary

With latitude for initiative and independent judgement within departmental guidelines, the position is responsible for managing both aged inpatient and outpatient accounts from the time that they have passed a certain aging threshold through the accurate resolution of the account. This position will also be responsible for the follow up and collection of accounts that are complex based on high dollar amounts, multiple payers, unique billing and/or payment arrangements, and specialized services. Revenue Collection activities focus on an assigned payer billed at the primary level. Activities performed will focus on resolving balances on aged insurance accounts which have not been collected through routine billing and collection activities, ensuring the visit balances on the accounts receivable are at expected reimbursement based on contractual agreements with payers, and determining and completing the collection process that will result in payment. Makes independent decisions as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues that affect reimbursement of claims and advising the management team of those trends and propose resolution. Maintain a detailed knowledge of billing requirements and regulations to ensure that the process conforms to federal and state regulations. The Revenue Cycle Coordinator IV will represent the department and the Hospital in a professional manner, protecting confidentiality of patient information at all times.

Supervision and Direction Exercised

The Inpatient/Outpatient Revenue Cycle Coordinator IV is responsible for self-monitoring performance on assigned tasks, following standard procedures, and as directed by the Manager, Billing or Manager. Independent judgement is necessary in escalating collection activities and determining violation of contracts.

Machines and Equipment Used

Standard office equipment, including but not limited to: telephone, photocopy machine, adding machine, personal computer (for claims inquiry and entry software), fax, scanner, EPIC billing application, Microsoft Word, Excel, Access, Email, various clearinghouse software, third party claims software, and various payer websites.

Typical Duties

30% Complete follow up activities on unpaid or under-paid accounts including complex high dollar and specialized accounts by contacting payer representatives or utilizing online systems with insurance companies and other third-party payers to obtain payments, research, and resubmit rejected claims to primary payers, obtain and verify insurance information.

• Follow up on unpaid accounts

• For unpaid accounts, check claim status on appropriate payer systems or contact an insurance representative to obtain information as to why claims are not paid and steps necessary for processing/payment.

• Initiate collection phone calls to insurance companies to determine reason for claim denial or reason for unpaid claim. Address unpaid claims, and solicit a payment date from the payer.

• Research and calculate underpaid or overpaid claims; determine final resolution.

• Re-calculate claim based on fee schedule, APC or APG grouper, appropriate % of charge, or ASC payment methodology, including add-ons

• Follow up with payers on incorrectly paid claims through final resolution and adjudication, including refund of credits

• Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers

• Work with supervisor/manager on communication to payer representatives regarding payment trends and issues
  25% Work weekly, bi-weekly, and monthly reports and work lists via calculating and processing transactions such as payer to payer transfers, contractual adjustments, verify that the insurance levels and proration are set up correctly in the system.

• Examples of reports:

• 2nd insurance level report

• Medicare and Medicaid credit balance report

• Over $10,000 report

• Claim Edits
  10% Payer Relations and Escalation Process

• Identify and clarify issues that requirement management intervention to avoid loss of revenue.

• Recommends the filing of a formal complaint with the State's regulation commission or agency.

• Determines when to change the account to a self-pay financial class after a review of previous efforts has not resulted in revenue collection and further attempts would not be successful without patient intervention.

• Identifies need for in-person meetings and phone conferences with third party insurance representatives due to claim and system issues requiring prompt attention for complex accounts.

• Prepares information for and attend meetings with third party insurance representatives on claims and system issues for scheduled in-person meetings and phone conferences regarding complex accounts.

10% Utilize a thorough knowledge of inpatient/outpatient billing policies and procedures for primary levels of third-party insurance; prepare log and related management reports when needed, price claims to establish the expected reimbursement in the revenue cycle system.

• Initiate payer-related accounts receivable report to determine which visits needs special attention and follow up to obtain correct full reimbursement

• Billing primary and secondary claims to insurance

• Review paper claims prior to billing. Review include potential of high cost, and late charges to facilitate any necessary manual keying into ancillary billing systems (ePaces, Emdeon, OmniPro, etc.)

20% Identify and clarify issues, payment variances and/or trends that requirement management intervention; assist management team with Medicare and Medicaid credit balance audits, and third-party payer audits.

• Coordinate responses and resolution to Medicaid and Medicare credit balances

• Review all accounts on the Medicaid and Medicare credit balance report

• Request insurance adjustments or retractions

• Prepare requests for insurance and patient refunds

• Enter notes into billing system documenting status or action taken
  5% Research and respond to third party correspondence, receive phone calls, explain policies and procedures involving routine and non-routine situations. Assist other areas with patient related questions. Communicate with other hospital departments and with government and commercial insurance companies. Any additional duties as assigned.

• Coordinate with other departments within the Hospital to get claim issues resolved and complete audits.

• Research and initiate suggestions to management to streamline processes and training materials

• Perform coverage for other positions and other duties of similar scope and complexity in regular combination with this position.

Expectations

• Participate in department staff meetings, education classes, and trainings.

• Stay current on HIPAA guidelines through education and reading monthly emails.

• Participate in URMC training such as Strong Commitment ICARE and Annual Mandatory in Service

Qualifications

Associates degree in Business Administration and 4-5 years of hospital patient accounting or consumer collections experience; or an equivalent combination of education and experience or certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience.

Note: This document describes typical duties and responsibilities and is not intended to limit managers from assigning other work as required.

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Pay Range

Pay Range: $21.50 - $29.03 Hourly

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.