Revenue Cycle Specialist (Private Medical Practice) - RL Center for Cosmetic Surgery & Medspa

SUMMARY OF POSITION

The Revenue Cycle Specialist is responsible for assuring compliance with all patient financial transaction matters including revenue cycle; deposit/pre-payments made via cash or credit card; service episode payments made via cash, check, ACH or credit; insurance payments; and, where applicable, refund payments and balance due follow-up activities. Where applicable, this individual will identify process/workflow improvement opportunities to ensure an ongoing state of compliance and actively assists in implementation, training, and follow-up by others. The Revenue Cycle Specialist will also be expected to manage pricing updates for insurance related fee schedules, with a focus on maximizing reimbursement rates based on payor allowable amount. Ensure statements of charges and billing perpetually reflect the active chargemaster schedule. Duties must be executed in a manner that upholds the practice's standards of excellence and in accordance with Federal, State, company, and employee handbook policies and procedures.

KNOWLEDGE, SKILL, & EXPERIENCE REQUIREMENTS

• Bachelor's degree from an accredited four-year college or university or equivalent combination of experience, education, and training that would provide the required knowledge and abilities
• Knowledge of ICD-10-CM and CPT coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines
• Certificate of Coding and Billing from an accredited program; maintaining proficiency
• Three years or more of related experience required
• Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff
• Excellent organizational and time management skills
• Proficient in payor contracting, credentialing providers and practices via CAQH, CMS, Availity and associated portals
• Proficient in full revenue cycle management (RCM) process
• Proficient in Microsoft Office Suite
• Ability to work in an environment where multitasking is required
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations
• Ability to read and interpret medical procedures and terminology
• Ability to develop training materials, make group presentations, and to train staff
• Ability to exercise independent judgment
• Consistently maintains confidentiality on all patient accounts and business matters

RESPONSIBILITIES include, but are not limited to:

• Serves as the lead for billing and coding questions from providers, staff, and patients; and strives for first-time resolution as errors are identified.
• Supports engagement and the relationships with vendors and payors to ensure timely resolution to inter-company matters and processing.
• Works internally to track accounts receivables; work externally to support claims concerns or issues; and ensures documentation for billing batches, EOBs, and outstanding claims are made in a timely manner
• Manages accounts receivable at industry standards including adhering to timely filing deadlines, monitoring status updates, and movement to collections/outstanding payments
• Coordinates the insurance billing function of the business office, and sees to the proper application of patient, insurance, and other payments
• Evaluates medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and guidelines.
• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10-CM and CPT codes.
• Reviews reimbursement claims for completeness and accuracy before submission to minimize claim denial
• Evaluates records and prepares reports on such topics as the number of denied claims or documentation or coding issues for review by management and/or professional evaluation committees
• Makes recommendations for changes in policies and procedures. Develops and updates procedures manuals to maintain standards for correct coding and billing practices, to minimize the risk of fraud and abuse, and to optimize revenue recovery
• Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines
• Reads bulletins, newsletters, and periodicals and attends workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation
• Educates and advises staff on proper code selection, documentation, procedures, and requirements
• Identifies training needs, prepares training materials, and conducts training for physicians and support staff to improve skills in the collection and coding of quality health data
• Manages appeals and denials with timely follow up to ensure payment
• Manages patients' copay, deductibles, patient responsibilities with diligence to proactively manage patient payments and avoid collections.
• Post all insurance related payments and managers third party payor sites and ensure all payments are accounted for
• Manages merchant chargebacks to ensure all funds are received
• Review/audit all End of Day paperwork and, as errors are discovered, shares that feedback with the appropriate staff member or leadership team member to enforce prescribed workflows and best practices
• Answers phone and electronic messages/needs in a polite and respectful manner; works hard to ensure priorities are set and deadlines are accomplished at all times throughout the operating year
• Accurately, timely and proficiently prepares and present all RCM, Accounts Receivable, and Payor business activity reports
• Intimately manages and employs our fee schedule relative to subscriber benefits to ensure accurate estimate generation
• Works collaboratively with department managers to lead optimal reimbursement protocols
• Actively participates in training, coaching, leadership and development of team leads and staff and mentoring others to ensure workflow meets best practice standards
• Manages credentialing process and payor contracting for all new providers, facilities and process for timely and accurate onboarding
• Updates and maintains provider and corporate logins and credentials through appropriate sites
• Work's with PHOs and vendors for payor contracting and physician staffing