Revenue Cycle Representative - Cash Management

This position will report to the Supervisor of Payment Posting and is responsible for posting payments and denials to claims filed directly to a patient's account, processing requested adjustments, refunds and follow up from work files. Applicant must interact with insurance carriers in all aspects of claim resolution. Applicant must possess strong customer service skills, be a team player, have the ability to multitask and be detailed oriented. Must have excellent grammar and English usage skills and the ability to deal effectively with difficult situations and individuals. Must have the ability to read an EOB and various financial and/or insurance documents. Consistently contributes equally to meeting productivity goals established for the work unit and/or consistently meets established individual productivity goals. Must be prepared to work overtime as needed including an occasional weekend and be understanding of the schedule changes that can occur during the last week of each month.

Responsibilities:

• Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims. Responsible for all aspects of insurance follow-up and collections including interfacing with internal and external departments to resolve discrepancies through charge corrections, payment corrections, writeoffs, refunds or other methods. Edit claims (DNB, Coverage Changes, Claim Edits, Stop Bills) within scope of authority (or escalate as needed) to meet and satisfy billing compliance guidelines for electronic submission. Contact insurance carriers to obtain authorizations and referral approvals for services and procedures. Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers. Submit requested medical information to insurance carrier.
• Responsible for the analysis and necessary corrections of patient invoices or accounts as it pertains to clean claim submissions or re-bills. Responsible for maintaining work queues. Access, review and respond to third party correspondence via Document Management system. Research and resolve a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, credit balances, sequencing of charges, and non-payment of claims. Contact patients, physicians and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods. Verify claims adjudication utilizing appropriate resources and applications. Post payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely and accurate manner.
• Reconcile accounts, research and resolve a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non-payment of claims. Respond to any assigned correspondence in a timely, professional, and complete manner. Identify issues and/or trends and provide suggestions for resolution to management, including payer, system or escalated account issues. May maintain data tables for systems that support Patient Accounting operations. Evaluate carrier and departmental information and determines data to be included in system tables. Read and interpret EOB’s (Explanation of Benefits).
• Maintain basic understanding and knowledge of health insurance plans, policies and procedures. Accurately and thoroughly document the pertinent collection activity performed. Participate and attend meetings, training seminars and in-services to develop job knowledge. Meet/Exceed Productivity and Quality standards.

Other Information

Education Requirements:
● High School Degree
Professional Experience Requirements:
● Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections). Prefer candidate that has medical billing experience. Epic experience is a plus.

Job Details