Revenue Cycle Specialist

Clerical/Administrative Support Phoenix, Arizona


Description

Immediately Hiring Revenue Cycle Specialists I & II’s and Receive a $1,000 Sign-On Bonus and a $5,000 Retention Incentive!

When you join our team as a full-time team member, you will receive:

  • Limitless growth and career advancement opportunities
  • Annual performance reviews and employee rewards program
  • 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
  • Wellness Program - Offering access to an expert Health Coach and wellness incentives to lower cost
  • Tuition reimbursement up to $1,000
  • Affordable health care plans: Medical, Vision, and Dental
  • 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 need

We have full-time positions available for Revenue Cycle I & II, working Monday-Friday from 8:00 a.m. – 5:00 p.m. The schedule may be flexible, pending the needs of the department.

The position is located at our 7th Street Outpatient site at 3737 N 7th St, Phoenix.

As the Revenue Cycle Specialist I, you are responsible for the lifecycle of claim management functions, including timely claim submission, collection, and reimbursements. The core responsibility of the Revenue Cycle Specialist is the engagement of accurate and timely claim submissions, working collaboratively with the Benefit Specialists and program staff on eligibility issues and obtaining authorizations and pre-certs as required by the individual insurance company. The Revenue Cycle Specialist I is also responsible for reconciling rejected claims from EMR and Clearinghouse vendors, including obtaining missing information, aging claims/follow-up, and limited charge entry.

Do you have the skills to advance to a Revenue Cycle Specialist II position? 

As the Revenue Cycle Specialist II position, you are 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 Revenue Cycle Specialist II's primary responsibility is ensuring proper follow-up on the back-end aspects of the revenue cycle process related to reimbursement, including projects, problem and issues escalation, A/R management and research. The Revenue Cycle Specialist II should possess a thorough understanding of payor guidelines and policies and be able to evaluate the effect of such changes in our internal workflows. 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 impacting revenue, cash collections and adjustments.

JOB REQUIREMENTS:

  • Requires a HS Diploma/GED. 
  • College diploma or Billing Coding certification preferred.
  • A minimum of one (1) years – (4) years of billing, revenue cycle, medical A/R experience, required.
  • Behavioral health billing knowledge is preferred.
  • Ability to obtain and maintain a Level One Fingerprint Clearance Card.
  • Knowledge of medical terminology, CTT, ICD-10, and procedural modifiers
  • Experience with a variety of contractual reimbursement arrangements.
  • Knowledge of Medicare, Medicaid and commercial payers’s claims and appeals processing

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
:
  • Responsible for the maintenance and data entry of patient insured and demographic information as related to clean claim submission.
  • Works in collaboration with program leadership to resolve demographic and enrollment errors.
  • Responsible for daily import of Medicaid demographic and enrollment files into PM system and work in collaboration with Eligibility and Benefits to verify and update payer information.
  • Perform benefit verification & prior authorization for Medicaid, Medicare, and commercial insurances, as needed.
  • Review information to ensure that it meets the medical and billing criteria or adjudication.
  • Perform benefit verification & prior authorization for Medicaid, Medicare, and Commercial insurances, as needed.
  • Verifies insurance benefits and obtains any necessary pre-authorizations from health plans.
  • Initiate and follow up on pre-determinations with applicable insurance in a timely manner.
  • Works closely with the clinics and insurance companies to ensure that benefits and authorizations are obtained prior to services rendered and throughout the patient’s remaining treatment plan.
  • Ensures physician documentation supports payer requirements for authorization processing.
  • Responsible for the collection and submittal of appropriate documentation to prove the medical necessity of authorized service per health plan guidelines.
  • Responsible for full-cycle billing efforts, including claim submission and timely adjudication.
  • Ensure services are billed timely and appropriately and rejects/errors are researched and resolved to meet timely filing deadlines.
  • Responsible for daily 837 claim file submissions to clearinghouses & Medicaid contractors
  • Works in conjunction with program staff to ensure data entry functions are completed prior to upload process.
  • Responsible for reviewing and researching items on the system-generated exception reports and ensuring completeness and readiness for clean claim submission.
  • Responsible for working claim aging reports ensuring a 45 day or less claim life cycle.
  • Perform, identify, collect, and confirm insurance coverage to include obtaining prior authorization, third party liability and coordinator of benefits.
  • Maintains professional growth and certifications by attending and participating in corporate, departmental, and individual training & development programs to develop and enhance skills.
  • To ensure compliance & adequate services, additional job duties may be required to meet the needs of the program and or department.

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.