Revenue Cycle Specialist - Critical Care

Job Type Full-time Description

Job Summary

Review and process claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for critical care clients.

Major Responsibilities/Activities

• Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance
• Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff
• Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues 
• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim
• Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion
• Regularly meet, and effectively communicate with, Sr. Revenue Cycle Manager, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs 
• Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though 
• Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved
• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness 
• Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs
• Conduct all job tasks, calls, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations
• Consistently support and demonstrate the company mission and values
• Provide WOW service to patients, answering their concerns, providing them all necessary information and maintaining HIPAA protocol
• Obtaining front end eligibility and benefit information and providing this information accurately and efficiently to the client. Completing pre-certifications when applicable
• Conduct payment audits on accounts to ensure maximum reimbursement was achieved 

Other Responsibilities/Activities

• Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Revenue Cycle Manager, Operations Manager or Director
• Serve as backup to other teams members as required, which may include billing
• Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist, Revenue Cycle Manager, Operations Manager, or Director

Requirements

Performance Requirements

• Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service Level Agreements, A/R Aging, Net Collection Percentages, Average Cash Per Trip, Denials, Rejections, Account Review Aging, and maintaining a 96% audit score monthly. 

Required Education, Skills, & Experience

• High School Diploma
• At least 1-2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience
• Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though 
• Ability to organize, prioritize and multi-task  
• Ability to learn, understand, and work within specific compliance, client, and payer requirements
• Approach all tasks, duties, and interactions with an attitude of continuous improvement
• Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duti