REMOTE Senior Revenue Cycle Specialist

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Job description

Roles and Responsibilities

The Revenue Cycle Specialist is well versed and crossed trained in all areas of the revenue cycle and accustomed to working in a high-volume environment. Key Responsibilities include:

• Performs manual and electronic posting functions for all payors/patient accounts, including cash balancing and reconciliation of bank deposits.
• Post payment corrections, payment transfers and NSF's.
• Research and clear unapplied accounts using established identification functions/process.
• Analyzes and correct insurance account receivable and payment posting ledger and posting errors
• Reviewing patient accounts to determine and correct any discrepancies; account audits, aging AR, unapplied adjustments, resolving credit balance, unposted payments
• Ledger accuracy and account integrity
• Thoroughly research all payor recoupments and identify errors and/or opportunity to dispute and restore loss in revenue. Research and validate patient refunds prior to processing refund to patient and or state for unclaimed funds.
• Maintains knowledge of insurance rejections/denial processing and appropriately posts information for collection and follow up activity.
• Research and follow up on all correspondence associated with assigned accounts, including EOB's and documentation letters and generate correspondence requesting required information, when necessary
• Responsible for all aspects of follow up and collections, including making phone calls, accessing payer websites. Identify issues or trending and provide suggestions for resolution.
• Accurately and thoroughly documents the pertinent collection activity performed. Review the account information and necessary system applications to determine the next appropriate work activity.
• Reviews investigate and resolves claims that have been rejected or denied by insurance.
• Initiates appeals and ensures all required documentation is submitted in the appeal process. Researches all denials and follow up as necessary
• Verify claims adjudication utilizing the appropriate resources and applications.
• Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds
• Answer patient billing questions and act as a resource for patient billing questions.
• Initiate telephone or letter contact to patients to obtain additional information as needed.
• Verification of insurance benefits utilizing website, fax and phone. Knowledge of plan types/builds and how to create within the system
• Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic claim submission.
• Processing dental clean claims for payment by all insurance companies to ensure appropriate and timely coding, billing and collections
• Manage and maintain assigned workload, complete reports, and resolve high priority and aged inventory.
• Responsible for meeting goals and objectives in assigned areas of revenue cycle operations
• Identifies problems or improvements within own areas, develops resourceful and alternative solutions for work improvement or problem solution
• Other duties and responsibilities as assigned by leadership

Qualifications and Education Requirements

Essential Qualifications

• Prior experience in Dental Office workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting process
• Must be knowledgeable of reimbursement/compliance process and procedures with all payors
• Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office-strong excel skills). Strong computer literacy, Excellent Math and problem-solving skills. Data entry and 10-key by touch.
• Strong interpersonal and organization skills. Ability to work within a team setting and as an individual contributor. Excellent oral and written communication skills
• Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures
• Organized work habits, accuracy, and proven attention to detail with strong analytical skills

PIeb5e-5389

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