Revenue Cycle Specialist II Hybrid

University Hospitals; Shaker Heights (OH); On-site; USD 52,000 - 76,000; Full time

Job summary

University Hospitals in Ohio is seeking a Medical Claims Specialist to submit and resolve inpatient and outpatient claims with moderate to high complexity. You will stay current with governmental and third-party billing requirements across facilities and physician entities.

In this role you will follow department policies, communicate with management and providers, analyze accounts, and drive timely claim resolution while protecting patient privacy and PHI.

Qualifications

• Experience submitting and resolving medical claims of moderate to high complexity.

Responsibilities

• Responds to management, staff, or physicians promptly.
• Maintains patient and physician confidentiality and professionalism.
• Follows department policies to ensure accurate claim resolution.
• Communicates via telephone, letters, e-mail, or internal correspondence to resolve inquiries.
• Attends team meetings.
• Reviews accounts and analyzes balances to collect payments for medical services rendered.
• Uses multiple system applications to review, update patient information and resolve outstanding AR balances.
• Assists in claims resolution analysis and provides feedback for improvements.
• Performs follow up with insurers to ensure appropriate payment, resolve denials, correct claims, and appeal claims.
• Liaises with internal and external customers on receivables resolution in a high-volume environment.
• Documents accounts with clear verbiage per procedures.
• Reviews correspondence and inquiries received.
• Meets and exceeds team productivity and quality standards.
• Leads on special projects.
• Participates in staff training.
• Reviews complex claims issues for resolution and recommends process improvements.
• Performs other related duties as assigned.

Job description

A Brief Overview

Position responsible for submitting and resolving medical claims moderate to high complexity. Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.

What You Will Do

• Responds to requests from management, staff, or physicians in a timely and appropriate manner.
• Maintains patient and physician confidentiality and professionalism at all times.
• Follow department policies and procedures to ensure accurate and timely claim resolution.
• Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
• Attends and participates in team meetings.
• Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
• Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
• Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
• Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
• Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
• Documents accounts with clear and concise verbiage in accordance with departmental procedures.
• Reviews and responds to correspondence and inquiries received.
• Meets and exceeds team productivity and quality standards.
• Takes the lead on special projects.
• Participates in staff training.
• Reviews complex claims issues for resolution and recommends process improvements.
• Performs other related duties as assigned.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.