Revenue Cycle Specialist Senior Remote

University Hospitals Pain Management; Shaker Heights (OH); Remote; USD 45,000 - 60,000; Full time

Job summary

A leading healthcare organization is seeking a dedicated individual to manage and resolve medical claims. The role involves ensuring compliance with billing requirements, addressing patient inquiries, and training junior staff. This position is crucial for maintaining the integrity of the billing process across various facilities.

Qualifications

• Must stay current with governmental and third-party billing.
• Serve as a subject matter expert for junior staff.

Responsibilities

• Respond to requests from management, staff, or physicians.
• Follow up with insurance companies to ensure proper payment.
• Document accounts clearly and concisely according to departmental procedures.

Skills

Communication

Analytical Skills

Confidentiality

Tools

Excel

Job description

Description

Position responsible for submitting and resolving moderate to high complexity medical claims. Must stay current with governmental and third-party billing, follow-up, and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims across all owned facilities and physician entities, including internal and external policy adherence. This includes handling specialty billing claims, escalated accounts receivable concerns, and participating in special projects for the health system.

What You Will Do

1. Respond promptly and appropriately to requests from management, staff, or physicians.
2. Maintain patient and physician confidentiality and professionalism at all times.
3. Follow department policies and procedures to ensure accurate and timely claim resolution.
4. Communicate effectively via telephone, form letters, email, or internal correspondence to resolve patient inquiries and insurance issues.
5. Attend and participate in team meetings.
6. Review and analyze account balances using work lists to collect payments for medical services rendered.
7. Use multiple system applications to review and update patient billing information.
8. Act as a liaison with internal and external customers, providing assistance in claims and receivables resolution in a high-volume environment.
9. Follow up with insurance companies to ensure proper payment, resolve denials, correct claims, and appeal claims.
10. Contact patients and guarantors to obtain necessary billing information.
11. Document accounts clearly and concisely according to departmental procedures.
12. Respond to correspondence and inquiries received.
13. Serve as a subject matter expert and primary resource for questions from junior staff.
14. Conduct training and develop process documentation.
15. Assist management with special projects.
16. In the absence of management, lead workflow efforts.
17. Participate in or lead payer and departmental meetings as needed.
18. Provide feedback and suggestions for process improvements to management.
19. Meet and exceed team productivity and quality standards.
20. Analyze and resolve claims independently.
21. Create Excel spreadsheets for claim analysis and resolution.

Additional Responsibilities

• Perform other duties as assigned.
• Comply with all policies and standards.
• Refer to departmental documentation during orientation for specific duties and responsibilities.
• Maintain the security and confidentiality of Protected Health Information (PHI), completing annual training and adhering to UH policies and procedures regarding PHI use.