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Revenue Cycle Specialist III

Cranberry, PA

Provides support covering all aspects of insurance billing, claims follow up and collections, including direct contact to the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeal, non-payment, overpayments and underpayments.

Essential Functions

  • Ensures efficient processing of billing claims, insurance follow up, collection activities and denials. Assists in meeting cash collection goals by reviewing, completing, and submitting appropriate documentation based on payer requirements. Conducts research and provides updates and current status of collection efforts within the RCM system.
  • Performs billing, follow-up and collection functions for third parties, resolving issues that impact or delay claims payment. Communicates information and ideas to make system-wide process improvements. Updates data regarding changes and modifications in plan benefits and other contract information relevant to the billing or claims follow up and collection process.
  • Serves as support staff for various departments and external payers by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the organization. Reviews and responds to correspondence and inquiries generated by third party payers. Provides medical record copies and other pertinent information to the appropriate sources throughout the billing and collection process. Works 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.
  • Handle all correspondence within 1 week of receipt.
  • Work exception and rejection work queues, review EOB’s for correct contract payment.
  • Supports overall Revenue Cycle processes to achieve established targets and goals, including the completion of special/specific assigned projects or tasks.
  • Monitors the status of denials, appeals, and claim errors by using folders/work queues and conducting routine, periodic follow up on previously researched claims items. Monitors, reviews, and suggests 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
  • Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment. Maintains awareness of current regulations. Initiates practices that support current regulations.
  • Provides coaching and training to Revenue Cycle Specialists I and II. Serves as a SME (subject matter expert) to the RCM Department and Senior Management.
  • Runs reports and monitors productivity of assigned RCM team.
  • Performs other duties as assigned or required.

Qualifications and Skills

  • High School Diploma or equivalent; post-secondary education a plus.
  • Minimum of 6 years of healthcare related experience in billing and collections and professional organization (HFMA or AAHAM) certification to be obtained within 6 months of hire/promotion.
  • Knowledge of physical therapy billing preferred.
  • 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.
  • Insurance eligibility and benefit verification.
  • Ability to read and understand the information provided on EOB’s, remittance advices, and other insurance correspondence.
  • 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.
  • Knowledge of medical terminology and ICD-10 beneficial.
  • 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 paid vacation, 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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