Revenue Cycle Specialist- Follow up Primary Care

St. Elizabeth; Erlanger (KY); Hybrid; USD 42,000 - 66,000; Full time

Benefits offered by this job

Work from Home Opportunity after培训 (设备

Paid Time Off

Medical, Dental, and Vision

403b with Match

Opportunity for Growth

Job summary

St. Elizabeth is seeking a Revenue Cycle Specialist- Follow up Primary Care to manage patient communications and insurance follow-ups. The role emphasizes timely responses and precise data handling within a healthcare setting.

You will work on A/R reports, claim edits, EOBs, refunds, and updates to patient demographics, ensuring accurate postings and adherence to internal processes.

Qualifications

• High School Diploma or GED required.
• CPC certification required for designated trainer positions.
• Less than 3 years of experience in a medical practice, customer service or revenue cycle department.
• Knowledge of CPT, ICD9 and ICD10 codes.
• Knowledge of FDCPA and Bankruptcy.

Responsibilities

• Respond to patient and insurer inquiries within 1 business day.
• Handle A/R aging reports and correspondence daily.
• Refill and rebill claims to secondary insurance as needed.
• Post payments and adjust patient accounts accurately.
• Prepare and send patient statements and collection letters.
• Coordinate EOBs and requests for medical records.

Skills

Medical insurance knowledge

Customer service

Communication skills

Attention to detail

Education

High School Diploma/G.E.D.

CPC Certification

Tools

Quadax

Job description

Revenue Cycle Specialist- Follow up Primary Care

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 Description:

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.

Ref. Number

JR314859

Job Category

Patient and Clinical Support

Job Type

Revenue Cycle

Department

Corporate Follow-up Primary Care SEP

Shift

1st Shift

Hours

40 hours