The Revenue Cycle Specialist is primarily responsible for patient revenue management support throughout the revenue cycle, to include but not limited to: Claims Management, Accounts Receivable, Cash Posting and Denials Management.

Essential Duties:

May be required to do one or all of the following dependent on the RCM needs (including but not limited to):

• Claim Scrubbing/Submission

• Assists with third party billing process through the scrubbing, preparation and submission of accurate and complete claims in a timely manner.

• ERA Processing/Cash Posting

• Preparation and posting of daily cash receipts, Completion of daily transaction logs. Scanning, verifying and posting of remittances. Identification of unposted cash. Printing of posting reports for balancing.

• Accounts Receivable

• Resolve outstanding payer balances for assigned financial class by monitoring Accounts Receivable reports
• Follow-up on outstanding claims and submit appropriate documents for payment when necessary

• Denial Analysis/Management

• Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials working directly with the payers and/or clinics. Follow through on claim denials and rejections on timely basis

Skills and Qualifications:

• Possesses the ability to work in a constantly changing environment, good judgment skills, and capable of making decisions with attention to detail.
• Must have excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy.
• Must have excellent analytical and problem-solving skills.
• Ability to work easily and cooperatively with other departments.

• Ability to work independently and follow through on tasks without direct supervision.
• Ability to work well under pressure in a flexible, diplomatic and expeditious manner.
• Maintains strict confidentiality of patients’ medical records and adherence to all HIPAA policies and regulations.

Knowledge Required:

• Minimum 2 years Revenue Cycle experience in a healthcare setting
• Must have excellent computer knowledge of Patient Accounting systems
• High School Diploma or equivalent required. Associates or Certification(s) a plus.