Revenue Cycle Specialist

Job Summary

Review and submit medical encounters to insurance companies for payment. Work directly with the provider, insurance company, and/or the patient to have claims processed and paid in a timely manner. Answer billing questions and inquiries from patients and/or providers. This position requires great attention to detail, the ability to multi-task, prioritize, and possess excellent customer service skills.

Essential Functions

• Review all open tickets assigned to a patient and/or insurance group to ensure they are ready for insurance submittal daily

               o  Ensure accurate ICD-10 and HCPCS/CPT code assignment

               o  Ensure all documentation requirements for procedures billed and coded are met

               o  ‘Approve’ accurate claims

• Query providers when code assignments are unclear, or documentation is inadequate or incomplete
• Submit secondary billing in a timely manner with all supporting documentation
• Review, work, and/or appeal any denied or unpaid claims
• Accurately post insurance and patient payments to appropriate accounts
• Handle collections and unpaid accounts by establishing payment arrangements with patients

               o  Monitor payment plans

               o  Follow up with patients if/when there is a lapse in payment

               o  Send accounts to outside collection agencies if/when failure to establish or comply with payment plan

• Resolves patient inquiries and issues regarding billing or collections (In-person visits and phone calls)
• Run, work, and manage an assigned patient and/or insurance group A/R report
• Run, work, and manage an assigned patient and/or insurance group Credit Report

               o  Convey credit balances to any outstanding balances

               o  Complete/process paperwork for patient or insurance refunds

• Identify and analyze any billing issues and/or trends; communicate to the appropriate personnel

               o  CHCCW billing staff

               o  CHCCW providers

               o  Supervisor

• Contact insurance companies when necessary

               o  Verify eligibility and benefits

               o  Payment discrepancies

               o  Claim inquiries

• Maintain knowledge of insurance policies and guidelines

               o  Medicare

               o  Medicaid

               o  Managed Care Plans

               o  Commercial

               o  Workers Compensation

• Learn and/or maintain current knowledge and guidelines of various code sets

               o  ICD-10

               o  HCPCS

               o  CPT

• Gain coding/billing certifications

               o  Online courses

               o  Certification Exam

• Perform all other duties as assigned by the supervisor

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Minimum Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and ability required. Working in the patient information office may expose this position to sensitive and/or confidential information which must be held in confidence.

• High school diploma or equivalent and 0-3 years of medical billing and coding experience.
• Must be willing to obtain AAPC or AHIMA coding and/or billing certification within one year of employment with CHCCW.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully.

• While performing the duties of this job, the employee is required to drive; handle paperwork; operate computer equipment; and communicate effectively both in writing and orally with patients, staff and the public.
• Work is performed in a typical medical clinic and business office environment.

               o  Some travel by automobile may be required, as well as possible short-term assignment to other sites.

• Work is primarily indoors with prolonged periods of sitting, typing, and viewing a computer monitor.

               o  May also involve periods of standing, walking, bending, lifting, pulling, and pushing.

               o  Work in a clinical setting has potential for exposure to blood and body fluids, chemicals, and infectious pathogens.

               o  Must be able to use protective equipment as required.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.  

This position requires successful completion of substance abuse testing as a condition of employment.

We are an Equal Opportunity Employer and provider of services. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law. Community Health Center of Central Wyoming (CHCCW) is committed to creating an inclusive environment for all employees and patients and complies with applicable provisions of Section 1557 of the Affordable Care Act, Title VII of the Civil Rights Act, the Americans with Disabilities Act (ADA), and Section 504 of the Rehabilitation Act.