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Revenue Cycle Specialist II

Cranberry, PA

The Revenue Cycle Specialist II will provide support for all aspects of insurance billing, as well as claims follow up and collections. This position will have direct contact with the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeal, as well as non-payment, overpayments, and underpayments.

Essential Functions

  • Ensure efficient processing of billing claims, insurance follow up, collection activities, and denials. Assist in meeting cash collection goals by reviewing, completing, and submitting appropriate documentation based on payer requirements.
  • Perform billing, follow-up and collection functions for third-parties, resolving issues that impact or delay claims payment. Update data regarding changes and modifications in plan benefits and other contract information relevant to the billing or claims follow up and collection process.
  • Serve as support staff for various departments and external payers by developing positive relationships with managed care organizations, outside agencies, and clinical areas within the organization. Review and respond to correspondence and inquiries generated by third party payers. Provide medical record copies and other pertinent information to the appropriate sources. Work collaboratively to facilitate the insurance billing and collections process to improve overall cash collection.
  • Professionally answer incoming telephone calls from Payers and patients providing answers to questions and concerns about billing statements. Return all unanswered calls within 24 hours of receipt and handle all correspondence within 1 week of receipt.
  • Work exception and rejection work queues and review EOB’s for correct contract payment.
  • Monitor the status of denials, appeals, and claim errors by using folders/work queues and conducting routine, periodic follow up on previously researched claims items. Monitor, review, and suggest revisions or updates to existing forms, documents, and processes required to facilitate timely billing and collections. Prepare and sends written appeals when necessary with appropriate documentation.
  • Ensure completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment. Maintain awareness of current regulations.
  • Provide guidance and support to Revenue Cycle Specialist I and assist Revenue Cycle Specialist Lead in various functions and projects. Strive to be a SME (subject matter expert) in RCM.
  • Support overall Revenue Cycle processes to achieve established targets and goals, including the completion of special/specific assigned projects and complete other duties/tasks as assigned.

Qualifications and Skills

  • High School Diploma or equivalent; post-secondary education a plus.
  • Minimum of 4 years of healthcare related experience in billing and collections and professional organization with Insurance eligibility and benefit verification experience. Knowledge of physical therapy billing preferred.
  • HFMA or AAHAM certification to be obtained within 1 year of hire/promotion.
  • Knowledge with CMS 1500 and UB04 Billing Forms, EOBs, claims, coding and charges is required.
  • Demonstrated knowledge of third-party and insurance companies’ operating procedures, regulations and billing requirements; i.e. Commercial, Medicare, Medicaid, etc.
  • Ability to read and understand the information provided on EOB’s, remittance advices, and other insurance correspondence.
  • Knowledge of medical terminology and ICD-10 beneficial.
  • Excellent verbal and written communication skills
  • Effective customer service skills with the ability to interact with both internal and external customers, i.e. patients, insurance payors, Patient Care Coordinators and therapists in a professional manner.
  • Ability to prioritize work, handling daily and multiple tasks to completion within the time allotted, while working as part of a team within a demanding environment.
  • Proficiency with Microsoft Office tools with a sharp technical aptitude.
  • Ability to work independently with minimal supervision.

Phoenix offers a competitive salary and benefit package that includes PTO, holidays, optional participation in medical, dental and vision coverage, life and disability insurance, and 401(k).

Phoenix is an E-Verify and Equal Opportunity Employer.

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