Revenue Specialist I
Job Summary: Performs patient accounting functions including billing, collections, customer service, and cash applications; documents patient account activity; responds to customer billing inquiries; posts payments; implements billing guideline changes and identifies trends at a payer specific level; applies federal and state guidelines to collection efforts; interprets and follows up on Explanation of Benefits; inventories supplies; reports and tracks equipment maintenance; performs other duties as assigned by management.
Reports to: Collection Manager
Position Level: 6
Essential Functions of the Position:
- Run and work a Summary Aging Report Monthly:
- Work all accounts aging 30 days and greater by Insurance/Provider.
- Contact the Insurance carrier to confirm claims are on file and in process to pay.
- Review explanation of benefits to ensure the claims have processed per our contractual agreement.
- Run and work Denial Work List report weekly:
- Identify any claims that have denied and contact the carrier. All denials should be appealed for medical necessity when warranted.
- Clinical task the office or billing department if the denial is related to no authorization, diagnosis/cpt conflict, etc.
- Review and work all clinical tasks within 7 business days.
- Resubmit any corrected claims for reimbursement.
- (Any Insurance denial trends should be brought to the attention of the Collection Manager).
- Prepare for Monthly Divisional Meetings
- Collectors should run AR for meetings.
- All accounts should be documented.
- Review any claims that may have denied that are not on the denial work list report.
- Quality and Quantity of work
- Work mail daily
- Work all adjustments, any over $75.00 must have prior approval from the Collections Manager which is approved weekly.
- Write up refunds requests from Insurance carriers that do not recoup.
- Job Knowledge/Contractual Reimbursement:
- Knowledge of contractual reimbursement per Specialty.
- Review CCI/CPT for correct billing.
- Understand site of service differentials
- Understand when multiple surgical reductions apply.
- Identify underpaid/overpaid claims
- Prepare for monthly divisional meetings.
- Access Claims Tracker.
- Access ERA Manager.
- Utilize the Internet for multiple job requirements.
- Rebill all 2ndry claims that are not on file.
- Contact the patient for additional information when necessary.
- Assist patient with any billing or collection questions.
- Fax claims to carriers to ensure claims are received.
- Reallocate misapplied payments and adjustments.
- Work special assignments as needed.
- Maintain an organized and clean work area.
- Phone etiquette.
- Quantity and quality of work overall.
- Adheres to FMC policies and procedures
Physical and Mental Demands:
- Normal physical ability to sit for long periods of time while on the phone.
- Maintaining a positive and professional attitude.
- Able to handle stressful situations.
- Able to meet deadlines.
- High school graduate or GED equivalent
- Excellent telephone etiquette
- Basic computer knowledge
- Analytical skills
- Ability to manage multiple tasks
- Prior collection experience
- Computer skills (Internet, Excel, Word, etc)
- Communications skills, written and verbal
- Strong Team Player
- Above average proficiency in use of 10 key
- Minimum of one year related experience preferred