[Hiring] Revenue Cycle Specialist @Hunter Health

Role Description

The Revenue Cycle Specialist is responsible for working with insurance companies and patients to promote the growth of patient service revenue. The role involves reviewing medical, radiology, obstetrics, dental, and vision claims to ensure current and accurate patient account records and accounts receivable. The Revenue Cycle Specialist functions in accordance with established federal, state, and clinic standards, while complying with all federal grants and Hunter Health Clinic (HHC) policies and procedures.

Essential Functions:

• Provides accurate and timely submissions of claims according to payer rules and guidelines.
• Posts payments, slides, and adjustments to patient pay accounts accurately.
• Prepares and mails paper claims in a timely manner.
• Assists with reviewing and processing aging monthly claims.
• Communicates with patients, payers, attorneys, and program contacts regarding claims, billing concerns, collections, or financial transactions.
• Provides input to the Director of Revenue Cycle on benchmarks and progress on billing goals.
• Manages and monitors clearinghouse, payer portal rejections, and return-to-payer claims.
• Handles any rebills or resubmissions of claims, as necessary.
• Batches and posts payments and adjustments to patient accounts according to payer and departmental guidelines.
• Reviews remittance advice and denials from third-party payers to ensure accuracy.
• Assesses reports and ensures that all open claims have been resolved and billed accurately.
• Builds relationships with third-party payers, providers, and other representatives.
• Attends insurance training sessions and other meetings to stay abreast of current medical and dental billing rules and regulations.
• Travels when necessary to meet operational needs.
• Performs all other duties as assigned.

Qualifications

• High school diploma or GED is required.
• 1-3 years of experience in medical and/or dental billing, health care administration, or a related field is preferred.
• Knowledge of Medicare, Medicaid, private payer, workers' compensation, and third-party liability rules for accurate billing is required, with knowledge of FQHC billing a plus.
• Current working knowledge of ICD-9 coding is required, and ICD-10 and DSM coding knowledge, along with CPT (Level 1 HCPCS), Level 2 HCPCS, and ADA codes, is preferred.
• Medical billing and/or medical coding certification is preferred.

Requirements

• Listens, identifies, and responds quickly and effectively to internal and external needs.
• Communicates effectively with all patients, providers, and stakeholders.
• Displays organizational skills, abilities to multi-task, and uses time and resources effectively.
• Displays good judgment and decision-making skills.
• Effectively collaborates and seeks clarification and confirms accuracy as needed.
• Utilizes teamwork to achieve desired results and contributes to projects while developing positive working relationships.
• Pursues goals with commitment and takes initiative eagerly.
• Demonstrates accuracy, thoroughness, and reliability; manages time and priorities; develops and follows work procedures.
• Evaluates own performance and accepts constructive feedback to continue learning.

Benefits

• 20 days of PTO per year, plus 10 paid holidays.
• Employer-paid Benefits include:
• Basic life insurance
• Short-term disability
• Long term disability
• Employee Assistance Program with 12 free sessions per year
• Optional Benefits include:
• Medical
• Dental
• Vision
• Supplemental life insurance
• Accident and critical illness insurance
• Identity Theft Insurance
• 401k with Safe Harbor Plan match