Revenue Cycle Specialist- Follow up Primary Care

St. Elizabeth Physicians; Erlanger (KY); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Work from home after training

Paid time off

Medical, dental, and vision insurance

403b with match

Growth opportunities

Job summary

St. Elizabeth Physicians is seeking a Revenue Cycle Specialist- Follow up for the Primary Care Department. The role reports to the Revenue Cycle Manager/Administrator of Revenue and focuses on timely responses to patient calls, A/R work, EOBs, and accurate data updates in the practice management system.

The position handles claims filing, refunds, adjustments, and coordination with payors. The role requires CPC for trainers and a high school diploma, with non-exempt, regular full-time hours and

Qualifications

• 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.

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.
• Refil[e] 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 effectively with payors, patients/family members, physicians, support staff, coworkers, and management.
• Answer incoming calls professionally and within 3 rings; return voicemails within 1 business day.
• Update patient demographics and profile information.
• Enter Financial Hardship information and apply adjustments in PM system.
• Responsible for NSF postings, letters, follow-up, tracking checks and adjustments.
• File claims to various insurance companies.
• Edit and entry of all claims (office, hospital, nursing home).
• Post payments, medical records and disability payments.
• Balance and document payments; adhere to processes.
• Respond to refund requests from insurance companies promptly.
• Analyze overpayments and determine refunds due.
• Keep an accurate refunds log for month-end reporting.
• Audit statements and process weekly reports.
• Send and track patient statements and collection letters.
• Set up payment plans or arrangements.
• Work all correspondence/C15/C11 reports.
• Refer accounts to collection agencies.
• Post agency payments and verify commissions.
• Perform claims follow-up.
• Send medical records requests and note accounts.
• Coordinate pulling, copying and mailing of EOBs for primary/secondary refiles.
• Log bad addresses and notify offices.
• Manage Working Claim Edit (Reg) WQ and Working Errors in Quadax.
• Track envelopes.
• Other duties as assigned.

Skills

Medical insurance knowledge

Understanding EOBs

FDCPA knowledge

Attention to detail

Education

High School Diploma/G.E.D.

CPC certification

Job description

Job Summary

Reports to Revenue Cycle Manager and/or Administrator of Revenue

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- Follow up Primary Care Dept.

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.