Revenue Cycle Specialist- Collections

SEP Summit Medical Group, Inc.; États-Unis; Hybride; USD 42 000 - 64 000; Plein temps

Avantages offerts par ce poste

Work from Home Opportunity after培训 (设备

Paid Time Off

Medical, Dental, and Vision

403b with Match

Opportunity for Growth

Résumé du poste

St. Elizabeth Physicians seeks an experienced Revenue Cycle Specialist to handle patient and insurer communications, process claims, and manage accounts receivable workflows.

The role emphasizes timely phone responses, accurate data entry, and coordination with insurance companies to maximize claim processing and payments. Primary responsibilities include reviewing EOBs, posting payments, and applying adjustments while maintaining compliance with FDCPA and healthcare regulations.

Qualifications

• Knowledge of medical insurance, CPT/ICD codes, and EOBs.
• Ability to read and interpret explanations of benefits.
• Detail-oriented with accuracy in postings and adjustments.

Responsabilités

• Respond to patients and insurer inquiries in a timely manner.
• Follow up on A/R aging reports and correspondence daily.
• Refiling claims to secondary insurance when needed.
• Post payments and make adjustments to patient accounts.
• Coordinate sending of EOBs and refunds when required.

Connaissances

Medical insurance knowledge

FDCPA knowledge

EOB interpretation

Detail-oriented

Communication with payors

Formation

High School Diploma/G.E.D.

CPC certification

Outils

Quadax

Description du poste

Job Type: Regular

Scheduled Hours: 40

Job Summary: Reports to Revenue Cycle Manager and/or Administrator of Revenue Cycle Services, the Revenue Cycle Specialist is primarily responsible for receiving and responding to patients’ phone calls within one (1) business day, working A/R reports and Explanations of Benefits from insurance companies. They are responsible for working correspondence, refiling unpaid or incorrectly paid claims, and accurately updating or correcting patient demographic or profile information. They are responsible for the filing of claims to all insurance companies, analyzing and responding to refund requests as indicated by the insurance companies, and the entry and editing of all charges.

Job Title: Revenue Cycle Specialist- Collections Department

BENEFITS

• Work from Home Opportunity after training (Equipment Provided)
• Paid Time Off
• Medical, Dental, and Vision
• 403b with Match
• Opportunity for Growth

DUTIES AND RESPONSIBILITIES

• Provide information and resolve issues from patients/family members and insurance companies.
• Work Adjustment, Zero Pay, and A/R aging report and correspondence daily.
• Follow-up with the insurance company as needed regarding payment/non-payment of claims.
• Refile claims to secondary insurance when claims have not been received or processed.
• Submit activity log, audit journals, EOBs, and Account Follow-Up Logs daily.
• Communicate in an effective and professional manner with payors, patients/family members, physicians, support employees, co-workers, and management.
• Answer incoming calls in a professional and courteous manner within 3 rings. Return all voicemail messages within one (1) business day.
• Update patient demographic and profile information provided by patient, office, or insurance company.
• Enter Financial Hardship information and apply the appropriate and correct adjustments to Practice Management system. Make corresponding adjustments to the patient’s account.
• Responsible for NSF postings, letters, follow-up, tracking of checks and making necessary adjustments to patient's account.
• File claims to various insurance companies.
• Edit and entry of all claims including office, hospital, nursing home.
• Payment posting of patient payments, medical records and Disability payments.
• Adhere to company and system processes, post payments to appropriate accounts, with accurate documentation and balancing.
• Respond to refund requests from insurance companies in a timely manner.
• Analyze overpayments as marked by payment posters to determine if a refund is due.
• Keep an accurate log of refunds for month-end reporting.
• Audit statements and make appropriate corrections. Process weekly reports.
• Responsible for sending out and tracking patient statements and collection letters.
• Set up payment plans or payment arrangements.
• Work all correspondence/C15/C11 reports.
• Refer accounts to collection agencies.
• Post agency payments - verify commissions.
• Perform claims follow-up.
• Responsible for sending medical records requests to offices and noting the accounts.
• Responsible for coordinating the pulling, copying and mailing of EOBs for primary and secondary claim refiles.
• Responsible for logging bad addresses and sending notification to the offices.
• Responsible for Working Claim Edit (Reg) WQ
• Responsible for Working Errors in Quadax
• Keeping Track of Envelopes
• Other Duties as Assigned

OTHER REQUIRED SKILLS AND KNOWLEDGE

• Knowledge of medical insurance, managed care plans, CPT, ICD9 and ICD10 codes.
• Ability to read and understand Explanations of Benefits from all insurance companies.
• Knowledge of FDCPA and Bankruptcy.
• Detailed and thorough work on special projects as assigned.

EDUCATION: Minimum: High School Diploma/G.E.D.

YEARS OF EXPERIENCE: Less than 3 years of experience in a medical practice, customer service or revenue cycle department.

LICENSES AND CERTIFICATIONS: CPC required for designated trainer positions as well as those involved in coding directly from the chart.

FLSA Status: Non-Exempt Right Career. Right Here. If you have a passion for taking care of the community and are interested in Healthcare, you will take pride in the level of care we provide at St. Elizabeth. We take care of patients and each other.

St. Elizabeth Physicians is an equal opportunity employer and will not discriminate on the basis of race, color, sex, religion, national origin, ancestry, disability, age or any other characteristic that is protected by state or federal law.

St. Elizabeth Healthcare is one of the oldest, largest and most respected medical providers in the Northern Kentucky, Southern Indiana and Greater Cincinnati region.

Together with St. Elizabeth Physicians, the affiliated multi-specialty physician and advanced practice provider organization, we are transforming healthcare through innovative treatments, cutting-edge technology and a heart for our community. We’re right here, sharing one mission: to improve the health of the people we serve.