Revenue Cycle Specialist
- 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, Supervisor Claims Management, 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
- Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager
- Serve as backup to other teams members as required
- Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist or Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager
- 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.
- 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 duties
- Ability to function well within a cross-functional team setting and independently
- Detail-oriented
- Resourceful
- Self-starter
- Must possess critical thinking/analytical skills
- Proficient in Microsoft Office programs
- Strong preference for prior EMS billing and/or denials experience
- Proficient in EMS|MC billing software
- General office environment
- Frequent typing
- Sitting, standing, walking
- Use of basic office equipment such as computer, fax, printer, copier, and telephone
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