Reporting to the Chief Operating Officer, the Revenue Cycle Specialist is responsible for monitoring the revenue cycle of the agency and works to decrease claim submission denials, improve collections, and meet accounts receivable targets. The specialist will support the revenue cycle of over $8 million dollars with primary payers of Medicaid, MCO's, and other third-party payers. PRIMARY RESPONSIBLITIES Proactively assess internal and external factors and regulations with the potential to impact... more details
POSITION SUMMARY
Reporting to the Chief Operating Officer, the Revenue Cycle Specialist is responsible for monitoring the revenue cycle of the agency and works to decrease claim submission denials, improve collections, and meet accounts receivable targets. The specialist will support the revenue cycle of over $8 million dollars with primary payers of Medicaid, MCO's, and other third-party payers.
PRIMARY RESPONSIBLITIES
Proactively assess internal and external factors and regulations with the potential to impact the revenue cycle positively or negatively.
Analyze revenue cycle problem areas, provide leadership in implementing effective and measurable actions to resolve problems that clog the revenue cycle.
Monitor improvements regarding the first-time submission of clean claims, resubmissions, and outstanding collections to not exceed 60 days.
Work collaboratively and serve as the primary point of contact with third party billing contract (InSync) billing team and provide oversight of the technical work of the contract to ensure deliverable meet Hillcrest requirements.
Facilitate weekly revenue cycle meeting and provide daily follow-up to ensure timely completion of tasks for all members of the RC team to include program and clinical managers, client enrollment and eligibility staff.
Pursues collections of all claims with insurance companies.
Maintains the claims issue log and ensures that claims are resolved and submitted timely.
Escalates unresolved problems to the COO.
Demonstrates knowledge of, and supports, clinic mission, vision, values statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
Performs other work associated with the billing process to assure the proper billing and payment process for the clinic.
EDUCATION
Successful completion of high school or commercial coursework including math, bookkeeping, and business.
Post high school work in insurance billing, data processing and medical terminology preferred.
REQUIREMENTS
Five years prior experience in billing of third-party insurances for facility and professional services required.
Medical coder certification with emphasis on behavioral health care preferred.
Strong written and verbal communication skills.
Proficient with Microsoft Office Suite with emphasis on Excel.
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