Revenue Cycle Representative

The Ohio State University Physicians, Inc.; Columbus, Northern (OH, KY); Hybrid; USD 25,000 - 37,000; Full time

Job summary

The Ohio State University Physicians, Inc. is seeking a Revenue Cycle Representative in Columbus, OH to manage insurance billing, denials and appeals, and ensure timely reimbursements across multiple payer networks.

You will verify patient demographics and insurance information, process invoices, monitor aging claims, and collaborate with physicians, insurers, and third parties to resolve issues in accordance with policy. Strong communication and organizational skills are essential.

Qualifications

• High School diploma or equivalent with two or more years of medical billing experience; or equivalent combination of education and experience.
• Knowledge of insurance carrier payment policies, practices and amounts.
• Evidence of organizational and problem-solving skills, and ability to manage multiple priorities.
• Ability to effectively communicate both verbally and in writing.
• May be required to work under time pressures or demanding requests from various staff members and departments.
• Must be able to interact and communicate with individuals at all levels of the organization.
• Preferences: Experience with EPIC, Clearinghouse Vendors and Imaging software systems

Responsibilities

• The Revenue Cycle Representative uses knowledge of invoices, claims, insurance billing, collections and medical terminology to complete multiple tasks related to insurance billing.
• Acts as a liaison between the physician, insurance companies and third parties by processing and verifying invoices, ensuring payment of claims and reviewing insurance reimbursements.
• Responsible for the tracking of claims throughout the Revenue Cycle and the billing process to identify problem areas and determine a course of action in resolving aging claims.
• Follows governmental regulations and policies outlined by OSUP.
• Reviews, verifies, obtains and corrects patient demographics and insurance information, medical diagnosis, lab and other diagnostic services information, hospital service dates, and required authorizations.
• Provides problem resolution on payer 277 rejections and denials and follow-up on issues as needed.
• Coordinates and analyzes EOBs for denials and irregularities, institutes appropriate actions, and reprocesses claims per policy.
• Investigates and resolves unpaid claims timely to maximize reimbursement.
• Researches and resolves missing or conflicting patient information; requests completion of additional forms for denied claims.
• Updates work queue and invoices for collection activity according to Department guidelines.
• Reconciles accounts; adjusts balances to reflect denials, adjustments, payments and modifications.
• Identifies trends impacting revenue and communicates issues to management for solutions.

Skills

Denials and appeals experience

Medical billing

Communication

Organization

Education

High School Diploma or equivalent

Tools

EPIC

Clearinghouse Vendors

Imaging software

Job description

Overview

Looking to join our dynamic team at Ohio State University Physicians where excellence meets compassion?

Who we are

With over 100 cutting-edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part.As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth.

Our culture

At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community.

Our benefits

We know that having options and robust benefit plans are important to you. OSUP prioritizes the wellbeing of our team and that’s why we offer our employees a flexible, competitive benefit package. In addition to medical, dental, vision, health reimbursement accounts, flexible spending accounts, and retirement, we also offer an employee assistance program, paid time off, holidays, and a wellness program designed to support our employees so they can live their best lives. As an OSUP employee, you will be eligible for these various benefits depending on your employment status.

Responsibilities

• Must have denials and appeals experience

The Revenue Cycle Representative uses knowledge of invoices, claims, insurance billing, collections and medical terminology in order to complete multiple tasks related to insurance billing. Acts as a liaison between the physician, insurance companies and third parties by processing and verifying invoices, ensuring payment of claims and reviewing insurance reimbursements. Responsible for the tracking of claims throughout the Revenue Cycle and specifically the billing process to identify problem areas and to determine a course of action in resolving aging claims. Follows all governmental regulations as well as policies and procedures as outlined by the OSUP. Duties and Responsibilities include:

• Reviews, verifies, obtains and corrects patient demographics and insurance information, medical diagnosis, laboratory and other diagnostic services information, hospital service, applicable dates, required authorizations and certifications, signatures, and other information related to preparation and processing of insurance bills, and eligibility of coverage.
• Provides problem resolution on payer 277 rejections and denials and follow-up on issues as needed.
• Coordinates and analyzes EOB’s for denials and irregularities, institutes appropriate actions, and reprocesses claims in accordance with Company policy.
• Investigates and resolves unpaid claims timely to accurately maximize reimbursement.
• Research and resolves missing or conflicting patient information; requests completion of additional forms or information for denied claims or special processing requirements.
• Updates work queue and invoices for collection activity according to Department guidelines.
• Accurately reconciles accounts; adjusts balances to reflect denials, adjustments, payments and other modifications to balances.
• Responsible for identifying trends which impact revenue, communicates identified issues and trends to management. Participates in analysis and solutions to reduce and resolve denials.
• Responsible for the follow up on A/R research projects; review status of accounts, action taken, and further course of action if warranted; provides updates to manager regarding status of A/R projects.
• Provides problem resolution on denials and follow-up issues as needed.
• Attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with co-workers and supervisors, and politeness to customers, vendors, and patients.
• Other duties or special projects as assigned.

Qualifications

• High School diploma or equivalent with two or more years of medical billing experience; or equivalent combination of education and experience.
• Knowledge of insurance carrier payment policies, practices and amounts.
• Evidence of organizational and problem-solving skills, and ability to manage multiple priorities.
• Ability to effectively communicate both verbally and in writing.
• May be required to work under time pressures or demanding requests from various staff members and departments.
• Must be able to interact and communicate with individuals at all levels of the organization.
• Preferences:Experience with EPIC, Clearinghouse Vendors and Imaging software systems

Pay Range

USD $18.20 - USD $27.29 /Hr.