Specialist- Revenue Cycle

Billing & Follow Up:

• Process Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format.
• Billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim.
• Information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment.
  Denial Management:
• Manage denial receivable to resolve accounts
• Develops strategy for appeal, appeal follow-up and/or reprocessing accounts
• Analyze denials to determine reason they occurred
• Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager
• Takes corrective action through systematic and procedural development to reduce or eliminate payment issues
  Contract Management:
• Familiarity with payer methodologies and the ability to communicate with NMHS staff
• Manage paid claims to resolve underpaid accounts
• Develops strategy for appeal, appeal follow-up and/or reprocessing accounts
• Analyze underpayments to determine reason they occurred
• Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager.
  Communication:
• Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance
  Liaison:
• Contacts insurance companies regarding denial, underpayments or rejection issues
• Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues
  Reporting:
• Assists in preparation of monthly denial reports and other denial reports as requested
• Assists in preparation of monthly variance reports and other variance reports as requested.
  Regulation:
• Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.
  Job Knowledge:
• Bachelors degree in business, coding or equivalent field required; with a minimum of 2-year Claims, Billing/ Follow-Up, or revenue cycle experience required. Willing to consider 6 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of degree.
• Experience/knowledge of managed care reimbursement methodology including ICD-10, CPT-4 and/or HCPCS and DRGs, required
• Ability to research, analyze and communicate payer trends to identify reimbursement and training issues.
• Excellent analytical and problem-solving skills required
• Good organizational and communication (written and verbal) skills; required
• Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites; preferred
• Excellent interpersonal skills; required.