Job Summary

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

Major Responsibilities/Activities

• Monitor and analyze outstanding facility accounts receivable for assigned clients while suggesting solutions to maximize client performance
• Initiate timely and proactive communication to facility payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues
• Prepare, review, and send invoices to facility payers on a monthly or other specifically noted interval
• Ensure special invoice processes are documented and completed as required by facility
• Maintain a list of contacts for each facility to establish open communication and increased responsiveness
• 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 and Revenue Cycle Managers 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
• 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

Other Responsibilities/Activities

• 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 team 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

Performance Requirements

Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service Level Agreements, Account Review Aging, monitoring of incoming facility payments and facility payer education regarding consolidated billing

Requirements

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 knowledge of facility billing and consolidated billing guidelines
• Ability to organize, prioritize and multi-task
• Ability to learn, understand, and work within specific compliance, client, and facility 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 facility 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

Preferred Education, Skills, & Experience

• Strong preference for knowledge of prior health insurance claims and/or denials experience and/or facility billing

Working Environment/Physical Requirements

• General office environment
• Frequent typing
• Sitting, standing, walking
• Use of basic office equipment such as computer, fax, printer