Revenue Cycle Management Specialist

DEPARTMENT: Revenue Cycle Management
REPORT TO: Manager, Revenue Cycle Management
STATUS: Non-exempt
UNION AFFILIATION: Non-union
SCHEDULE: Full time

JOB OVERVIEW:
The Revenue Cycle Management Specialist will be responsible for assisting in the patient accounts management. He or she will perform required medical billing and collections for physician services within the EPM/EMR environment. Additionally, he or she will be responsible for maintenance of EPM Master Files and reconciliation of HIP CAP Membership and Payment Rosters with EPM/EMR system.

ESSENTIAL FUNCTIONS:
1. Claims ensuring timely and accurate payment of all A/R, collections and aged patient accounts;

2. The Revenue Cycle Management Specialist will process capitation charges, ensuring effective claims submission and processing through the coordination and delivery of all patient account information HIP;

3. Participate in the review of physician encounters submitted for reimbursement ensuring the use of appropriate and accurate diagnostic codes;

4. Perform necessary research and data management to ensure reconciliation of HIP CAP Membership and Payment Rosters with EPM/EMR system;

5. Troubleshoot and resubmit claims when a patient is identified with an insurance change;

6. Provide essential support to the Revenue Cycle Manger, in the oversight, audit and reconciliation processes related to the department and overall billing function

7. Maintain and update EPM system Master Files as coordinated with IT and credentialing department, and;

8. Provide some level of support, guidance and/or supervision to subordinate billers in the absence of the Manager.

SKILLS REQUIRED:
1. Significant experience and competency in ICD-9 and CPT coding; with significant experience with HCFA 1500 claims processing.

2. Will posses demonstrated knowledge and experience with Medicare Regulations and significant experience of the health care industry particularly as it relates to understanding HMO/PPO functions and multi-physician specialty billing.

3. Highly proficient in the use of various computer applications, particularly Microsoft Word and Excel; practice management systems (e.g. NextGen).

4. Proficiency with data entry, management and analysis.

5. Must be exceptionally attentive to details and follow through.

6. Demonstrated ability to assume a leadership role within the department.

EXPERIENCE REQUIRED:
A minimum of three (3) years medical billing experience utilizing electronic transactions is required. In addition, the ideal candidate will have experience with NextGen and EDI Vendors and Vendor Reports.

EDUCATION REQUIREMENTS:
Minimum requirement is a High School diploma or equivalency. Completion of billing curriculum from an accredited billing school or program is highly desirable.

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