[Hiring] Revenue Cycle Specialist II @University Hospitals

Role Description

Position responsible for submitting and resolving medical claims of moderate to high complexity. Must remain current with governmental and third-party billing, follow-up, and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.

• Responds to requests from management, staff, or physicians in a timely and appropriate manner.
• Maintains patient and physician confidentiality and professionalism at all times.
• Follows department policies and procedures to ensure accurate and timely claim resolution.
• Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
• Attends and participates in team meetings.
• Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
• Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
• Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
• Performs follow-up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
• Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
• Documents accounts with clear and concise verbiage in accordance with departmental procedures.
• Reviews and responds to correspondence and inquiries received.
• Meets and exceeds team productivity and quality standards.
• Takes the lead on special projects.
• Participates in staff training.
• Reviews complex claims issues for resolution and recommends process improvements.
• Performs other related duties as assigned.

Qualifications

• High School Equivalent / GED (Required)
• Associate's Degree (Preferred)
• Bachelor's Degree (Preferred)
• 1+ years medical billing / claim experience (Required)
• Experience with medical billing software (Preferred)

Requirements

• Must have a working knowledge of claim submission (UB04/HCFA 1500) and third-party payers. (Required proficiency)
• Knowledge of procedural and ICD10 coding. (Required proficiency)
• Basic knowledge of medical billing terminology. (Required proficiency)
• Detail-oriented and organized, with good analytical and problem-solving ability. (Required proficiency)
• Notable client service, communication, and relationship-building skills. (Required proficiency)
• Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
• Must have strong written and verbal communication skills. (Required proficiency)
• Demonstrated ability to use PCs, Microsoft Office suite (including Word, Excel, and Outlook), and general office equipment (i.e., printers, copy machine, FAX machine, etc.). (Required proficiency)

Physical Demands

• Standing: Occasionally
• Walking: Occasionally
• Sitting: Constantly
• Lifting: Rarely up to 20 lbs
• Carrying: Rarely up to 20 lbs
• Pushing: Rarely up to 20 lbs
• Pulling: Rarely up to 20 lbs
• Climbing: Rarely up to 20 lbs
• Balancing: Rarely
• Stooping: Rarely
• Kneeling: Rarely
• Crouching: Rarely
• Crawling: Rarely
• Reaching: Rarely
• Handling: Occasionally
• Grasping: Occasionally
• Feeling: Rarely
• Talking: Constantly
• Hearing: Constantly
• Repetitive Motions: Frequently
• Eye/Hand/Foot Coordination: Frequently

Travel Requirements

• 10%25