Description

The Revenue Cycle Specialist has experience working in a Hospital Business Office, experience with following up on denied accounts, appeals, and reconcile the denial and ensure payment.to the Hospital. Medi-Cal experience is a big plus for this work.

ESSENTIAL FUNCTIONS

• The Patient Financial Services Billing Specialist is responsible for all aspects of billing primary, secondary, and tertiary payers facility claims including:
• Identifying issues or trending and provide suggestions for findings and claims activity performed.
• Review the account information and necessary system applications to determine the next appropriate work activity.
• Verify claims have passed edits utilizing appropriate resources and applications.
• Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers.
• Edit claims to meet and satisfy billing compliance guidelines for electronic submission.
• Manage and maintain worklist inventory, complete reports, and resolve high priority and aged inventory.
• Participate and attend meetings, training seminars and in-services to develop job knowledge.
• Participate in the monthly, quarterly and annual performance evaluation process with Supervisor.
• Respond timely to emails and telephone messages as appropriate.
• Communicate issues to management, including payer, system or escalated account issues.
• Maintains information or operational records; screens reports for completeness and mathematical accuracy; list, abstracts, or summarizes data; compiles routine report from a variety of sources.
• May, as a secondary responsibility, review notes, receipts, permits, licenses, etc., computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; keeps records, and prepares reports in accordance with pre-determined forms and procedures.
• Prepares billing documents for collection of revenues from third party payer programs and patients; checks and verifies charge rates for services; reconciles patient account balances verifies payments
• Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Mental Health, and insurance programs; assures that all appropriate medical documentation is included in the billing package.
• Other duties as assigned

Requirements

REQUIREMENTS:

• 3-5 yr experience working in a Hospital Business Office, experience with following up on denied accounts, appeals, and reconcile the denial and ensure payment to the Hospital.
• Also, in the absence of Denial specific work, we will talk to someone that has extensive experience in a Hospital Setting doing account follow up and resolving balances to ensure timely payment to the hospital.
• EPIC experience required.
• Medi-Cal experience is a big plus.
• HS Diploma.

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