Revenue Cycle Specialist - Remote - United States

JOB SUMMARY 

Responsible for managing patient account staff in processing accounts and working with designated payers to ensure proper reimbursement.  Ownership of assigned Payer AR and all activities required to identify underpayments and prepare accounts for escalation to the payers in order to drive account resolution.  Resolve claims in a timely manner by completing appeals as needed or driving materials and accounts through the Plan Manager to the Payer.  

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Manages the aging of accounts receivable by trending and analyzing the A/R, and through communication with the payers/managers. Monitors collection processes to determine cash flow improvement opportunities.
• In depth knowledge of applicable contracts.  Continual QA and analysis of underpayment risk areas to ensure audit accuracy.  Ensure compliance with state and federal laws and regulations.  Maintains a thorough understanding of health insurance and government programs, where necessary.
• Prepare escalation packages, pre demand packages and any necessary Payer materials with corroborating contract support for submission to the Manager and ultimately the Payer.
• Monitor payer memos and create communication on changes to support teams
• Respond to claim denials from insurance companies to ensure contractual payment of submitted claims and Resubmit claims and write appeals to insurance companies
• Collaboration with various support teams on identified issues (includes issue logs).  

SUPERVISORY RESPONSIBILITIES 

If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. 

No. Direct Reports (incl, titles)     Patient Acct Reps, Sr Patient Acct Reps, Lead Patient Acct …