Revenue Cycle and Follow Up Specialist

ADP, Inc.; Washington (District of Columbia); On-site; USD 52,000 - 64,000; Full time

Job summary

Healthcare Legal Solutions, LLC is seeking a detail-oriented Revenue Cycle/Follow Up Specialist in the DC area to pursue unpaid third-party claims and standard appeals. You will communicate with payers to expedite payments and progress the standard appeals process for denials, while updating registration data and supporting documentation as needed.

The role is full-time (40 hrs/week), with preference for candidates in the DC-Maryland-Virginia area.

Qualifications

• Bachelor’s degree or 1–2 years related experience or equivalent mix of education and experience.
• BA/BS with a GPA of 3.0 or higher.
• Interest in healthcare and healthcare law.
• Ability to use hospital billing and patient information systems.
• Familiarity with HIPAA rules and PHI handling.
• Able to navigate multiple computer systems to access insurance claim info.

Responsibilities

• Identify unpaid claims for collection/appeal using follow-up systems.
• Progress standard appeal process for denied claims.
• Gather and verify data for clean claims, including billing procedures.
• Review and update patient registration and demographics as needed.
• Resolve claim edits and escalate when necessary.
• Prints and mails appeals and related documents as needed.
• Retrieve supporting docs and submit to third-party payers.
• Identify primary vs secondary insurance issues and COB eligibility.
• Contact payers or patients to obtain corrective action and payment.

Skills

Communication skills

Prioritization

Multi-tasking

Attention to detail

Organizational skills

Verbal/written communication

Microsoft Office

Excel

Word

Education

Bachelor’s Degree (BA/BS) or 1–2 years related experience

Tools

Microsoft Office

Word

Excel

Job description

Healthcare Legal Solutions, LLC is a fast-growing healthcare collections firm that provides denial management, consulting, and corporate collections services to hospitals and health systems nationwide. Our team is collaborative, mission-driven, and focused on results. This is a great opportunity for candidates who are passionate about healthcare, legal writing, and strategy.

Position Overview

We are seeking a detail-oriented, organized, and assertive individual for our Revenue Cycle/ Follow Up Specialist position. The candidate would be responsible for the basic collection of unpaid third-party claims and standard appeals, using various billing applications and third-party payer systems. A successful applicant will communicate with payers to resolve issues and facilitate prompt payment of claims. This position requires follow-up with insurance companies to progress the standard appeals process for claim denials and collect outstanding accounts for which payment has not been received. The candidate will use an understanding of claims and appeals submission requirements for payers to expedite payments and utilize a knowledge of appeals and rejections processes to resolve standard issues or elevate to a more senior staff member. This is a full-time (40 hrs/ week), with preference for candidates in the DC-Maryland-and Virginia area.

Specific Duties & Responsibilities

• Use HLS follow-up systems to identify unpaid claims for collection/appeal
• Use HLS follow-up systems to progress the standard appeal process for denied claims
• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract
• Review and update patient registration information (demographic and insurance) as needed
• Resolves claim edits as needed
• Escalates any faulty accounts for correction, additional review, or delegation to more senior staff members
• Prints and mails appeals and related documents as needed
• Retrieves supporting documents (medical reports, Explanations of Benefits authorizations, etc.) as needed and submits to third-party payers
• Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility, and any other issue causing non-payment of claims
• Contacts the payers or patient as appropriate for corrective action to resolve the issue and receive payment of claims

Professional & Personal Development

• Participate in on-going educational activities, meetings, and opportunities
• Keep current of industry changes by reading assigned material on work related topics

Qualifications

• Bachelor's Degree (BA/BS) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience.

Other qualifications

• BA/BS with a GPA of 3.0 or higher
• Interest in healthcare and healthcare law
• Ability to use various hospital, billing, and patient information computer systems
• Familiarity with compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI)
• Able to navigate through various computer systems and applications to find information about insurance claims
• Ability to prioritize and multi-task
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office, including Word and Excel
• Excellent organizational and time management skills
• High attention to detail
• Clear, concise, and logical writing style
• Continuous performance improvement and ability to implement feedback