Revenue Cycle Specialist II - Patient Business Services

POSITION SUMMARY:

The Revenue Cycle Specialist II will be responsible for the review, minor analysis, trending and follow up of Third Party Claims Reimbursements to include the identification, billing and collection of payments. The Revenue Cycle Specialist II will actively engage with other departments to ensure timely resolution of all outstanding accounts to ensure maximum reimbursement.

PRIMARY ACCOUNTABILITIES:

• Apply advanced knowledge of payer contracts, payment polices, and regulations to ensure correct payment of claims

• Demonstrate thorough knowledge of complex insurance correspondences to include explanation of benefits, remittance advices and denial letters.

• Verify insurance benefits, understanding insurance payments, denials and correspondences through Advanced understanding and ability to navigate payer websites and vendor applicable systems

• Maintain established quality assurance and productivity benchmarks while utilizing best practice standards established.

• Process all referrals in timeframe established by department

• Accurately update account in all systems to reflect work being preformed

• Apply logic and critical thinking to identify payer trends resulting in payment delays

• Communicate identified payment trends to leadership promptly and accurately and provide solutions to resolve challenges and issues.

• Assist with training and mentoring of new hires

• Ensure compliance with state and federal laws regarding all aspects of role.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities.

MINIMUM QUALIFICATIONS:

• Education: High School Diploma or GED

• Licensure: None Required

• Certification: None Required

• Work Experience in Related Field: One year experience in Healthcare Billing and/or AR follow up or related field

• Work Experience in Lieu of Degree: N/A

• Knowledge/Skills/Abilities: Microsoft Office

• Outlook, Word, Excel, PowerPoint

PREFERRED QUALIFICATIONS:

• Education: High School Diploma required or GED

• Licensure: None

• Certification: None

• Work Experience in Related Field: Two year progressive experience in Healthcare Billing and/or AR follow up or related field.

• Work Experience in Lieu of Degree: N/A

• Knowledge/Skills/Abilities: Critical thinking, Decision-making skills

PHYSICAL REQUIREMENTS:

Sedentary

• Office Workers

• Sedentary work involves sitting most of the time

• Walking and standing or lifting more than 10 pounds are required only occasionally

• Must be able to tolerate long periods of computer time a day

• Must be able to tolerate long periods of phone time a day

• Ability to enter information using hand/wrist dexterity

• Visual acuity and hand-eye coordination to preform various tasks