Revenue Specialist I

US-FL-Land O'Lakes
# Positions
25
Category
Office and Administrative Support
Department
*9401 CENTRAL BUSINESS OFFICE
Job Status
Regular Full-Time
2150 Via Bella Boulevard

Job Description

Revenue Specialist I

Department:               CBO

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                        

 Additional Responsibilities: 

  • 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. 

General:

  • 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. 

Job Qualifications:

  • 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

 

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