Revenue Cycle Specialist for Palliative Care-2

Jacksonville, FL 32257

Under the direction of the Patient Accounting Manager, act as liaison to Revenue Cycle Management (RCM) software Company for insurance, claims, and payments questions/issues. Review and submit all visit charges generated by Palliative Care Practitioners to RCM for billing and collections. Coordinate all remit denials and claims issues and complete the month end reconciliation for Community Palliative Consultants using financial reports provided by RCM monthly.

• Verifies all insurance information prior to entering the payer in EMR/billing software and retains copies of the insurance verification.
• Review all claims encounters to ensure all information necessary is provided and accurate prior to sending a completed claim (visit charges).
•  Submits to RCM for processing all visit charges generated by CPC practitioners daily.
• Reviews all alerts/task messages received from the RCM for any errors/items that require review for possible correction by provider.
• Work with RCM third party claims service to set up EDI services for claims submission.
• Review all claims encounters to ensure all information necessary is provided and accurate prior to sending a completed claim.
• Act as primary resource for RCM third party claims service to provide feedback on all questions in reference to payments being applied in accordance with company policy using the Reasonable and Customary rates.  
• Handle all self pay accounts following company policy, once the final statement has been sent out by the RCM third party biller.
• Receives and handles all communications regarding standard patient pay statement calls including general statement questions, disputed or overdue payments. 
• Promptly enters all patient pay payments received by the patient into EHR system.
• Process all credit/debit card payments over the phone and directly deposit funds into the designated CHPC operating account   
• Reviews the financial reports which include accounts receivable reports and CPT utilization reports. 
• Furnish and/or assist RCM with obtaining access to payer websites.
• Maintain the Medicare direct data entry (DDE) process.
• Attends the monthly conference call with RCM to discuss the standard financial reports or any billing related issues.
• Prepares the month end reconciliation using reports provided by RCM and balances the cash, adjustments, and billing monthly totals to the trail balance in the Great Plains Accounting system.
• Respond promptly and within no more than five (5) business days to any requests for response or follow up sent by RCM.
• Handles all request for refunds due to overpayment received with respect to any claim or bill or that any billing impropriety has occurred. 
• Must complete all RCM Services training provided.
• Responsible for complying with all applicable (federal and state) laws and regulations as well as CHPC contractual agreements related to the submission of claims for practitioner services.
• Provide RCM Company with all documentation received form payers, including, but not limited to explanations of benefits, payer newsletters, pre-existing questionnaires, using the storage and notification methods specified by the RCM.
• Maintain up to date fee schedules.
• Maintain and follow company policy for collections and refunds.
• Works with RCM and staff accountants to ensure monthly cash sheet totals for the operating account reconciles with the remits received for each financial class/payer.

Education/Experience:

Any combination of education and experience that would provide required skills

and knowledge for successful performance would be qualifying.  Typical qualifications would be equivalent to:

• Minimum three (3) years experience as a medical biller or similar role in a (Professional) Healthcare setting. 
• Experience with Windows, accounting software and data entry.
• Working with medical payers including, Medicare Medicaid, and commercial insurance.

  Knowledge of:

• Medical Billing software and electronic medical records.
• Insurance verification process and authorization requirements.
• Insurance reimbursement guidelines including HMO/PPO, Medicare, Medicaid and other payer requirements and systems.
• Revenue cycle and how the various components work together preferred.

   Skilled at:

• Excellent written and verbal communication skills
• Multitask and manage time effectively.
• Ability to work independently and with minimum supervision.

To apply please email your resume to Tiffany.Roddy@AliviaCare.com