Revenue Cycle Specialist Temp (22-19-268T)

The Stamford Hospital Stamford , CT 06901

Posted 3 months ago

ORGANIZATION BACKGROUND:

About Stamford Health

Stamford Health is a non-profit independent healthcare system with more than 3,500 employees committed to compassionately caring for the community and offering a wide-range of high-quality health and wellness services. Patients and their families can rely on comprehensive person-centered care through the system's 305-bed Stamford Hospital; Stamford Health Medical Group, with more than 30 offices in lower Fairfield County offering primary and specialty care; a growing number of ambulatory locations across the region; and support through the Stamford Hospital Foundation. Stamford Health is also a major teaching affiliate of the Columbia University College of Physicians and Surgeons. Dedicated to being the community's most trusted healthcare partner, Stamford Health puts patients first to build long-lasting relationships. For more information, visit StamfordHealth.org. Like us on Facebook and follow us on Twitter, YouTube, and Linked In.

The Revenue Cycle Specialist is responsible for supporting either the Accounts Receivable team or the Customer Service and Cash Applications team with a focus on one of the following groupings:

  • Denial Resolution: researching, resolving, and resubmitting denied claims; taking timely and routine action to collect unpaid claims; and interpreting various forms of explanations of benefits (EOBs) from insurance carriers

  • Customer Service: providing quality assistance to Stamford Health Medical Group's (SHMG) patients to resolve any and all billing-related questions; and ensuring proper demographic and insurance information for those patients serve

  • Cash Applications: entering patient and insurance payments, contractual allowances, denials, correspondence, and other adjustments into the medical group's practice management system; balancing and reconciling posting batches; and participating in month-end close

MAJOR RESPONSIBILITIES:

Denial Resolution Focus:

  • Understands and interprets insurance Explanations of Benefits (EOBs), knowing when and how to ensure that maximum payment has been received.

  • Researches and resolves rejected, incorrectly paid, and denied claims within an established time frame.

  • Researches and resolves unpaid accounts receivable and makes any corrections in medical group's practice management system necessary to ensure maximum reimbursement for all services rendered.

  • Resubmits claim forms as appropriate.

  • Professionally responds to all billing-related inquiries from patients, staff, and payers in a timely manner.

  • Utilizes available resources to identify reasons for payment discrepancies.

  • Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.

  • Accurately documents patient accounts of all actions taken.

  • Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements.

  • Educates clinic management and staff regarding changes to insurance and regulatory requirements.

  • Actively participates in practice management and payer meeting.

Customer Service Focus:

  • Greets in-bound calls from patients.

  • Responds professionally to all billing-related questions from patients.

  • Returns all phone messages within 24 hours of receipt.

  • Reviews patient account data when interacting with patients to ensure that accurate information regarding patients' insurance and demographic information are correctly reflected on the patient's account.

  • Updates insurance and demographic information as necessary on patient accounts.

  • Resubmits claim forms as appropriate.

  • Initiates requests for refunds to either patients or insurance companies.

  • Accurately documents patient accounts of all actions taken.

  • Identifies past due accounts and submits them to Collector for assignment to outside collection agency.

  • Establishes payment arrangements for patients on past-due accounts and when appropriate in accordance with policy, submits them to management for approval.

Cash Applications Focus:

  • Effectively posts insurance/patient payments, remittances, and correspondence to respective patient invoices, and when appropriate, transfers remaining balances to the next responsible parties.

  • Understands and interprets insurance Explanations of Benefits (EOBs).

  • Processes and posts electronic remittance advices.

  • Balances and reconciles each batch, using control mechanisms in accordance with policy.

  • Documents and notes all actions taken regarding patient accounts.

  • Responds professionally to all billing/cash-related calls and questions from internal customers within 3 business days.

  • Coordinates account resolution with accounts receivable team if and when appropriate.

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.

Required Skills

QUALIFICATIONS/REQUIREMENTS:

  • Associate's degree or medical billing certification preferred. CPC preferred.

  • 3+ years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.

  • 3+ years of experience working with a medical office/hospital accounts receivable system.

  • Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.

  • Demonstrates overall knowledge of claims processing for various insurances, including private and governed.

  • Comprehensive knowledge of ICD-10, CPT, and HCPCS coding.

  • Moderate to advanced 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.

  • Demonstrates the ability to carry out assignments independently, work from procedures, and exercise good judgment.

  • Demonstrates the ability to maintain the confidentiality of all records

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Revenue Cycle Specialist Temp (22-19-268T)

The Stamford Hospital