Revenue Cycle Specialist II
Description
Immediately Hiring a Revenue Cycle Specialist II to Join our Copa Team On-site!
Pay: $20.00-23.15hr
Pay: $20.00-23.15hr
What You’ll Get…
When you join our team as a full-time team member, you will receive:
- Limitless growth and career advancement opportunities
- Increased pay, based on annual performance reviews
- Career development offered internally through our Organizational Development & Learning Department
- Generous PTO program – up to 3 weeks off your first year with continued accruals each pay period!
- 9 paid holidays per year
- Access to health coach and up to $800 wellness incentives
- Tuition reimbursement up to $1,000
- Affordable health care plans: Medical, Vision, and Dental
- H.S.A., H.R.A, F.S.A. (with select medical plans)
- Free Short-Term Disability and Life/AD&D Insurance up to $100,000
- 403(b) retirement plans with company match.
- Employee Assistance Program Voluntary benefits: Long-Term Disability, Pet Insurance, Additional Life/AD&D Insurance, and much more!
Who We NeedImmediately Hiring a Revenue Cycle Specialist II at our Cambridge office in Phoenix, AZ.The Revenue Cycle Specialist II is responsible for identifying and resolving complex claims issues adversely impacting the revenue cycle management process and achieve resolution through coordination, reconciliation and denied claim management. The primary responsibility of the Revenue Cycle Specialist II is to ensure proper follow-up is performed on the back-end aspects of the revenue cycle process related to reimbursement, including projects, problem and issues escalation, A/R management and research. Additionally, follow internal and external policies and procedures and ensure proper revenue is booked by monitoring payments, fee schedule changes, health plan reimbursement changes and other aspects that impact revenue, cash collections and adjustments.
MINIMUM QUALIFICATIONS:
- High school diploma or General Equivalency Diploma (GED); or equivalency of education and years of experience
are acceptable.
- College or certification course work, preferred.
- 1-2 years of experience in medical claims required. Behavioral health knowledge preferred.
- Ability to obtain and maintain Level One fingerprint clearance and meet agency personnel requirements
JOB SUMMARY (INCLUDING, BUT NOT LIMITED TO)
Responsible for the payment & collection process for agency billed claims:
a) Performs full cycle billing and collections functions which includes a complex review of billing and
collection activities.
b) Interpret and analyze EOBs, remits and payment posting entries.
c) Check claim status from payers through telephone, websites, and any other communication deemed necessary for insurance carriers in a prompt and efficient manner.
d) Collect on insurance accounts by contacting insurance carriers and other third-party payers to verify receipt of billing and other information needed to process claims, secure approximate date of payment, negotiate with
claims personnel for prompt payment and resolve discrepancies in billing within appropriate time frames.
e) Categorize and quantify payer payment issues for resolution and reporting to Rev Cycle Manager.
f) Review and interpret explanation of benefits to determine contractual compliance, accuracy of payment
received, true patient responsibility, status of denied or reduction of service coverage and follow up
appropriately.
g) Researches, identifies and rectifies any special circumstances resulting in delayed payments.
h) Works aggressively with health plans regarding accounts that have aged over 30, 60 and 120 days
i) Research claims that have been paid incorrectly and ensure prompt payment.
j) Collaborate effectively with, Rev Specialist I, Billing Coordinator & Payer in a timely manner to resolve billing
problems and disputes.
k) Monitors the billing and collection electronic charge entry processes to ensure days in accounts receivable
comply with department standards.
Responsible for back-end claim processing and denial reconciliation:
a) Responsible for posting all third-party payments, denials and adjustments.
b) Provide all necessary follow-up including collections on outstanding claims via payor websites and IVR systems.
c) Investigates denials and verifies completeness and accuracy of program billing by collaborating and consulting with assigned Campus staff.
d) Reconciles claims submission with payments and denials as reflected on an Explanation of Benefits and resubmits denied claims within 30 days of receipt.
e) Draft correspondence to payers including 1st level appeals for technical denials, and corrected claim memos.
f) Works with Billing Coordinator to properly route adjudicated statuses that cannot be entered into PM System.
g) Reviews accounts receivable activities and calls on outstanding balances or claims.
h) Routinely research payer credit balances and regularly writes up request for refunds.
i) Manage EPM worklists and reports from TS for the reconciliation of unpaid or denied claims.
j) Works closely with Department Leadership and Credentialing Department to troubleshoot contract and
provider credentialing issues which have resulted in unpaid, denied or short pay claims.
k) Ensures timely and proper reimbursements by researching and resolving all aged receivables.
l) Performs basic Payer contract management assessing payer performance and payment accuracy according to contractual language.
- High school diploma or General Equivalency Diploma (GED); or equivalency of education and years of experience
are acceptable.
- College or certification course work, preferred.
- 1-2 years of experience in medical claims required. Behavioral health knowledge preferred.
- Ability to obtain and maintain Level One fingerprint clearance and meet agency personnel requirements
JOB SUMMARY (INCLUDING, BUT NOT LIMITED TO)
Responsible for the payment & collection process for agency billed claims:
a) Performs full cycle billing and collections functions which includes a complex review of billing and
collection activities.
b) Interpret and analyze EOBs, remits and payment posting entries.
c) Check claim status from payers through telephone, websites, and any other communication deemed necessary for insurance carriers in a prompt and efficient manner.
d) Collect on insurance accounts by contacting insurance carriers and other third-party payers to verify receipt of billing and other information needed to process claims, secure approximate date of payment, negotiate with
claims personnel for prompt payment and resolve discrepancies in billing within appropriate time frames.
e) Categorize and quantify payer payment issues for resolution and reporting to Rev Cycle Manager.
f) Review and interpret explanation of benefits to determine contractual compliance, accuracy of payment
received, true patient responsibility, status of denied or reduction of service coverage and follow up
appropriately.
g) Researches, identifies and rectifies any special circumstances resulting in delayed payments.
h) Works aggressively with health plans regarding accounts that have aged over 30, 60 and 120 days
i) Research claims that have been paid incorrectly and ensure prompt payment.
j) Collaborate effectively with, Rev Specialist I, Billing Coordinator & Payer in a timely manner to resolve billing
problems and disputes.
k) Monitors the billing and collection electronic charge entry processes to ensure days in accounts receivable
comply with department standards.
Responsible for back-end claim processing and denial reconciliation:
a) Responsible for posting all third-party payments, denials and adjustments.
b) Provide all necessary follow-up including collections on outstanding claims via payor websites and IVR systems.
c) Investigates denials and verifies completeness and accuracy of program billing by collaborating and consulting with assigned Campus staff.
d) Reconciles claims submission with payments and denials as reflected on an Explanation of Benefits and resubmits denied claims within 30 days of receipt.
e) Draft correspondence to payers including 1st level appeals for technical denials, and corrected claim memos.
f) Works with Billing Coordinator to properly route adjudicated statuses that cannot be entered into PM System.
g) Reviews accounts receivable activities and calls on outstanding balances or claims.
h) Routinely research payer credit balances and regularly writes up request for refunds.
i) Manage EPM worklists and reports from TS for the reconciliation of unpaid or denied claims.
j) Works closely with Department Leadership and Credentialing Department to troubleshoot contract and
provider credentialing issues which have resulted in unpaid, denied or short pay claims.
k) Ensures timely and proper reimbursements by researching and resolving all aged receivables.
l) Performs basic Payer contract management assessing payer performance and payment accuracy according to contractual language.
Copa Health is an Equal Opportunity Employer - All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, disability status, protected veteran status, or any other characteristics protected by law. Pre-Employment Criminal Background and Drug Testing Required. EOE.