Revenue Cycle Specialist II - Providence, United States - Brown Medicine

Description

SUMMARY:

Under the general direction of the Manager of Revenue Cycle, performs a variety of functions related to patient accounts to ensure the financial stability of the organization.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Applies the Brown Urology values of patient care priority, dignity, collaboration, integrity and quality in support of the Brown Urology mission to deliver compassionate, high-quality patient care, research excellence and outstanding physician education. Is responsible for knowing and acting in accordance with the Brown Urology Compliance Program and Code of Conduct.

Practices the Brown Urology Customer Service Standards.

• Maintain current knowledge of federal and state regulations regarding medical billing practices.
• Act as a resource to practice management and providers.
• Maintain knowledge of all applications including eClinical Works, Epic, Microsoft Word, Excel and on-line payer verifications/claims status.
• Submissions of claims to third party payers; ensure clean claim rates with submissions.
• Identify trends within the Accounts Receivable
• Verifies completeness and accuracy of all claims prior to submission.
• Timely follow up on insurance claim denials, exceptions, or exclusions.
• Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days.
• Refund processing for third party payors and patients.
• Research and analyze payments for discrepancies to companies and individuals.
• Accurately post all insurance and patient payments. Reading and interpreting insurance explanation of benefits.
• Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies.
• Respond to inquiries from insurance companies, patients and providers.
• Maintain patient confidentiality.
• Demonstrate flexibility to perform duties wherever volume deems it necessary within the billing area.

BASIC KNOWLEDGE:

• A technical understanding of reimbursement policies and procedures of various third-party payor and medical assistance programs to ensure billing procedures are compliant.
• Interpersonal skills to exchange information with patients, internal and external clients.
• Understand the basic reporting and balancing.
• Analytical ability to research and resolve billing problems, trending and to prepare statistical reports depicting billing activity.
• Knowledge of insurance guidelines
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Provide feedback to Brown Urology practices surrounding error trends with demographics, eligibility, and etc.

EXPERIENCE:

• High school diploma, GED
• Three to five years of progressively more responsible third-party payor billing.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

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

Work is performed in a typical office setting requiring extended periods of sitting, standing and walking.

INDEPENDENT ACTION:

Work is performed under general supervision, with some independent judgment exercised in determining priorities.

SUPERVISORY RESPONSIBILITY:

None.

EOE/F/M/Vet/Disabled

APPROVED BY:

Program Administrator Date

EOE/F/M/Vet/Disabled