Revenue Cycle Management Specialist

We are seeking a highly experienced Medical Billing- Revenue Cycle Management specialist to join our medical billing team. The ideal candidate will have a strong understanding of medical billing processes and terminology, experience in follow-up for Out-Of-Network providers, ensuring accurate and timely follow-up on billed claims.

Roles & Responsibilities:

• Responsible for claims follow -up, Professional and Facility, from claim submission until final payment

• Communicate with insurance companies regarding claim denials or underpayments

• Utilize Payer Online Portals such as Availity, Cignaforhcp, UHC, Navinet, Emblem for claims status and eligibility verification

• Send Medical Records to payers, filing reconsiderations and appeals

• Utilize providers EMR’s to obtain Medical Records

• Reading and understanding various payers EOB’s

• Posting payments, writing off balances and sending statements to patients, when necessary

• Communicating with 3rd party payers such as Multiplan, MARS and Zelis regarding OON claim negotiations.

• Follow up on Pre-negotiated Agreements a/k/a Single Case Agreements

• Review and verify accuracy of billing data utilizing Optum EncoderPro

• Utilize medical collection systems to track and collect payments

• Ensure compliance with all relevant coding and billing regulations

• Effectively resolve complex issues, including payment research, payment recoupments

• Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions

Experience & Requirements:

• Knowledge in Multi-Specialty coding - CPT and ICD codes for many different specialties

• Experience working with medical billing software like Imagine and ADS

• Familiar with Gap (Network Deficiency) exception and prior authorizations process

• Familiar with Federal IDR arbitrations process

• Familiar with OON Provider Registration Process with various Payers

• Knowledge of medical terminology (Hicfa, UB04, Tax ID, NPI)

• Strong attention to detail and persuasive telephone skills

• Excellent communication and interpersonal skills

• Solid skill with Microsoft Office applications: Word, Excel, Teams, Power BI reporting, Zendesk

• High School Diploma or equivalent

• Must have a minimum of 3 years’ experience in collections

Benefits:

• 401(k)

• 401(k) matching

• Dental insurance

• Employee assistance program

• Employee discount

• Health insurance

• Life insurance

• Paid time off

• Vision insurance

Work Location: In person

Job Type: Full-time

Pay: $22.00 - $25.00 per hour

Expected hours: 40 per week

Schedule: 8 hour shift

Place of work