Revenue Specialist II #54

Who We Are:

St. Johns Episcopal Hospital is the only hospital providing emergency and ambulatory care to the densely populated, culturally and economically diverse, and medically underserved populations of the Rockaways and Five Towns in southern Queens County and southwestern Nassau County, New York. Celebrating over 110 years of community care, the 257-bed facility provides people of all faiths with comprehensive preventive, diagnostic treatment and rehabilitative services, regardless of ability to pay.

Come Grow With Us!

Type: Full Time

Shift: Days

Hours: 8:00AM - 4:30PM

Pay: $65,000-$72,000

Job Description:

Ensures the financial integrity and Accounts Receivables by performing established financial processes that enable and expedite the billing and collection of professional services. This includes: creating claims according to Federal/Managed Care rules, regulations and compliance guidelines, patient account research and resolution, insurance verification and benefits determination, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance invoices, follow up and resolution of denied claims. Responsible for working correspondence denials and insurance follow up. This must be done in a timely and accurate manner, in accordance with provided work instructions by performing the following duties. Ability and certification for documentation auditing and provider education.

Responsibilities:

• Enter charges / approves claim creations in AthenaNet and submit appropriate claims for Real Time Adjudication

• Oversight and monitoring of Missing Slips to ensure timely charge capture

• Research and resolution of claims based on assignment, the process of which could include: o Contacting payers via phone or website, contacting practices, navigating cross-departmentally, writing appeals and facilitating their direction to Athena CBO for submission, and all other activities that lead to the successful adjudication of eligible claims

• Complete system knowledge relative to worklists, research and resolution of assigned Unpostables, payment batches

• Create patient cases to the correct clinical contact for additional information or corrections to be made with the appropriate details of what is needed

• Educate and effectively communicate revenue cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes

• Ability to run Zero-Pay Worklist, Fully Worked Receivables, complete special project work, review and respond to adjustments / payment data with approval (or initiate appeal) communicating trends and root issues through proper lines of reporting

• Ability to work on coding denials and appeals to Insurance Carriers

• Ability to code documentation for E&M and procedures

• Must have sufficient knowledge and understanding of insurance billing procedures to understand the reason for claims in HOLD, MGRHOLD and OVERPAID status and to make appropriate decisions for resolution

Requirements:

• High School diploma or Equivalency required, Bachelor's Degree preferred

• Minimum 2 years experience as a medical biller, working with EMR

• CPC or CSC Certification

• Proficient in Medical Terminology, ICD-10