Revenue Cycle Specialist

CCS Medical, Inc.; Clearwater (FL); On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

Remote or hybrid work options

401(k) with company match

Medical, dental, and vision insurance

Job summary

CCS Medical, Inc. is seeking a Revenue Cycle Specialist to manage claim submission and resolution for CCS Medical patients with governmental, commercial insurance, and patient accounts.

You will handle denial management, ensure proper documentation, and work to maximize reimbursements while maintaining confidentiality.

Qualifications

• Minimum of two years of medical billing/collections experience.
• Knowledge of reimbursement processes and procedures.
• Ability to work with others and provide assistance as needed.
• Excellent oral and written communication skills.
• Self-directed with ability to work with minimal supervision.

Responsibilities

• Manages a portfolio of CCS Medical billing/collection accounts.
• Assesses insurance reimbursement to maximize revenue.
• Verifies supporting documentation before billing/shipment.
• Posts payments and adjustments to accounts and resolves credits.
• Researches denials, initiates appeals, and follows up as needed.
• Communicates with insurers and patients to collect outstanding funds.
• Maintains documentation and reports trends to management.

Skills

Analytical skills

Excellent communication

Team collaboration

Self-directed

MS Office proficiency

Education

High school diploma or GED

Tools

MS Office

Medical billing software

Job description

Overview

Are you looking for a purposeful career that will make a difference in the patient community? At CCS, our approach to at-home patient care is redefining chronic care management. We are seeking individuals that will thrive in a patient-centric dynamic environment. If you are an attentive listener, fast-thinker, and problem-solver, with the ability to relate to different people, you are a match for CCS.

As aRevenue Cycle Specialistyou will be responsible for claim submission and claim resolution for CCS Medical patients regarding governmental, commercial insurance companies and patient accounts

Alaska, California, Colorado, Delaware, Hawaii, Idaho, Maine, Montana, Nevada, New Hampshire, New York, North Dakota, Rhode Island, South Dakota, Vermont, Washington, Wyoming; residents are not eligible.

Responsibilities

• Works individual portfolio of accounts from CCS Medical billing/collection system
• Assesses insurance reimbursement for individual supplies to ensure maximum reimbursement
• Verifies that all appropriate supporting documentation are obtained prior to shipment and/or prior to billing
• Audits configuration of supplies based on supporting documentation, formulary requirements and manufacturer compatibility
• Posting payments and / or adjustments to individual accounts
• Resolving credit balance accounts as needed
• Identifies problems or improvements within own area, develops resourceful and alternative solutions for work improvement or problem solution
• Researches and follow up on all correspondence associated with assigned accounts, including EOB’s and documentation letters, and generate correspondence requesting required information, when necessary
• Initiates appeals and ensure all required documentation is submitted in the appeals process. Research all denials and follow up as necessary
• Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds
• Reduces delinquent accounts and achieving maximum collections from all sources
• Produces reports identifying trends or problem carriers, and identify areas of concern and present ideas to correct or prevent future issues
• Analyzes and correct accounts receivable problems
• Documents all activities as completely as possible.
• Achieves productivity goals based on accounts touched, dollars collected, and aging period
• Reports any problems to the attention of the Management
• Must maintain a high degree of confidentiality at all timesdue to access to sensitive information

Qualifications

• High school diploma or GED equivalent.
• Minimum of two years of medical billing/collections experience necessary. Must be knowledgeable of reimbursement processes and procedures.
• Ability to work with other employees and provide assistance as needed.
• Proficient in basic PC skills. (MS Office).
• Organized work habits, accuracy, and proven attention to detail, with strong analytical skills.
• Ability to work within a team setting and as an individual contributor.
• Excellent oral and written communication skills.
• Self-directed with the ability to work with little or no supervision.
• Flexible and cooperative in fulfilling all obligations
• Ability to interpret rules and regulations set by Medicare, Medicaid, and Commercial payors.
• Ability, flexibility, and willingness to learn and grow as the company expands and changes.
• Ability to recommend and implement changes to processes for efficiency.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals; ability to write routine reports and correspondence; ability to speak effectively before groups of customers or employees of the organization.

Values

Values

Certainty-The lives of the individuals we serve depend on our ability to execute. We commit to doing this every day.

• Use appropriate methods and a flexible interpersonal style to help build a cohesive and collaborative team based on a foundation of trust and transparency. Deliver what you commit to.

Compassion-We understand the burdens of patients and their loved ones and channel this into a relentless pursuit of customer satisfaction in every part of our business.

• Ensure that the patient is the driving force behind business decisions, implementing service practices that meet needs of both the patient and the organization. Treat other the way you want to be treated.

Advancement-We are endlessly looking for ways to progress and become more innovative in all things we do.

• Encourage innovative approaches for addressing opportunities and facilitating change, driving cross-functional alignment to accomplish goals. Speak the truth.

CCS Medical and EEOC/AA employer. M/F/D/V

Company Overview

CCS is the strategic partner addressing America's most pressing healthcare challenges through intelligent chronic care management, tackling the $412 billion annual diabetes burden and chronic conditions affecting over 133 million Americans. At the core of CCS's differentiated model is LivingConnected, a human-led, digitally-enabled clinical solution. PropheSee, an AI-powered predictive model that identifies non-adherence risk and delivers personalized interventions, is an integral part of this solution, creating a first-of-its-kind platform to improve adherence, enhance clinical outcomes, and help prevent costly hospitalizations. By combining data-driven insights with three decades of industry relationships, CCS is the smart choice for health plans, providers, employers, and manufacturers who believe that value-based care starts by keeping patients healthy and delivers benefits like lower cost of care, improved HEDIS scores, and alleviating provider burnout. CCS's approach extends clinical reach while supporting over 200,000 people nationwide with home-delivered medical supplies and pharmaceuticals annually. Recognized as a Great Place to Work, and with numerous peer-reviewed publications validating our care management approach, CCS is more than a trusted supplier—we're a partner in transforming chronic care delivery. To learn more about how CCS is addressing today's healthcare challenges, visit ccsmed.com or connect with us on LinkedIn.

What We Offer

• Competitive Salary
• Bonus/Incentive Opportunities/commission:(if applicable)
• Comprehensive Benefits:
  • Medical, dental, and vision insurance
  • 401(k) with company match
  • Paid time off (vacation and holidays)
• Growth & Development:
  • Ongoing training and professional development
• Work-Life Balance:
  • Remote or hybrid work options
  • Wellness programs and mental health support