Revenue Cycle Specialist I

Position Summary

The Revenue Cycle Specialist I is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders. The Revenue Cycle Specialist I is responsible for generating accounts receivable revenue, processing claims, following up on claims, maintaining collection notes, posting deposits, submitting provider notifications, and balancing all aspects of accounts receivable. S/he also provides backup for accounts payable when accounts receivable revenue is involved, which includes working with hospitals and facilities to ensure accurate patient information. S/he is responsible for knowing and applying the rules and regulations of state and federal regulatory agencies and other certified agencies.

Position Specific Responsibilities

• Collects outstanding claims.

• Provides support and consultation to both corporate and branch personnel.

• Attends and participates in staff meetings.

• Communicates identified needs and potential solutions to Senior Specialist/Supervisor.

• Reviews and submits Notice of Elections and Notice of Revocation/Terminations as required for payors.

• When applicable review new admissions to verify payors and benefit periods.

• Runs pre-billing reports on assigned branches and pre-billing claims for review.

• Monitors and assists program branches as needed with financial classes and recertification dates.

• Generates Patient Revenue.

• Reviews and transmits/mails claims.

• Maintains knowledge of appropriate data required on claims.

• Assures filing of accurate claims according to payer specifications.

• Submits appropriate claims corrections or adjustments as needed.

• Documents required back up/approvals as required on revenue adjustments/changes and submits it to their Supervisor/Manager.

• Assembles required back up/approvals as required on revenue that will result in bad debt and submits it to their Supervisor/Manager.

• Works with branches, hospitals, and long-term care facilities as needed to ensure accurate billing and accounts payable information as needed.

• Able to self-organize work assignments to assure efficiency and effectiveness.

• Generates unbilled revenue reports at end of month and confirms all patients that were not generated are accounted for.

• Works the unbilled revenue report weekly by communicating missing information to the branches to ensure generation of all revenue.

• Maintains up-to-date knowledge of Insurance Contracts and notifies Senior Specialist/Supervisor/Manager in writing of any problems or deviation from contract.

• Maintains up-to-date knowledge of Medicare, Medicaid, and Private Insurance rules/procedures/and rates for billing.

• Monitors every outstanding claim on the aging report at least once every two weeks.

• Ensures that any account over 60 days old is being investigated on a consistent basis and documents every follow up attempt.

• Monitors for ADR's, or other payor request, needed to complete billing/collection process, on a weekly basis and notifies appropriate personnel.

• Performs quarterly status checks on all current ADR patients.

• Works Returned to Provider (RTP) claims in Medicare.

• Monitors Medicaid and Private Insurances websites, clearinghouses, and RA/EOB's on a daily basis to ensure that all claims are processing for payment.

• Performs monthly AR reviews and works with Senior Specialist/Supervisor/Manager to resolve problem accounts.

• Post Deposits daily or weekly as needed.

• Balances EOB/RA's to deposit entry and bank printouts.

• Assist with preparation and delivery of items required for branch or yearly audits as needed.

• Follows timekeeping and attendance policy daily.

• Performs other duties as assigned.

Education and/or Experience

• High school diploma or GED required.

• Experience in medical health care collections required, home health, hospice, palliative, or infusion collections preferred.

• Knowledge of Commercial, Third-Party Insurance Accounts, including but not limited to Medicaid, Managed Care, HMO, PPO, Auto and Work Comp rules and guidelines governing collection activities highly preferred.

Skills

• Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage. Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Proficiency in the use of a 10-key.

• Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications.

• Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces integrated healthcare at home philosophy.

Certifications, Licenses, and Registrations

• Medical Billing and Coding Certificate preferred.

Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 25 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization.

At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Estimated salary range $15.00 - $26.19 / hour. Actual salary will vary by geographic location and experience.