Revenue Cycle Specialist

Overview

Unified Women’s Healthcare is a company dedicated to caring for Ob-Gyn providers who care for others, be they physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this but executing on it.

As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our Ob-Gyn medical affiliates - enabling them to focus solely on the practice of medicine while we focus on the business of medicine.

We are action oriented. We strategize, implement and execute - on behalf of the practices we serve.

The Revenue Cycle Specialist ensures the financial integrity of accounts receivable by performing established financial processes that enable and expedite billing and collection for medical services. This includes editing and resolving claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance on invoices and follow-up and resolution of denied claims. This role is responsible for working correspondence denials and insurance follow up. This must be done in a timely and accurate manner, in accordance with provided work instructions.

Responsibilities

• Monitor and execute work on assigned claim worklists, AR worklists, reporting, projects, or team goals
• Oversee claim worklists and monitor open notes to ensure timely charge capture
• Research and resolve claims based on assignment, which could include contacting payers via phone or website, contacting practices, working across departments, writing appeals and facilitating their submission, and all other activities that lead to the successful adjudication of eligible claims
• Run reports for analysis, trending, and subdivision of work to communicate with internal stakeholders
• Manage and resolve posting issues, manage remittance and all correspondence in each of the EMR dashboards daily
• Manage and resolve the zero-pay worklist and fully worked receivables, complete special project work, review and respond to adjustments and payment data, and communicate trends and root issues through proper lines of reporting
• Work with and provide support to billing specialists, which may include onsite trainings and issue resolution
• Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws
• Ensure resolution of patient cases
• Meet productivity standards as set by management
• Inform management of correspondence and communication problems with service locations
• Maintain knowledge and understanding of insurance billing procedures to understand the reason for claims requiring edits (i.e., in HOLD, MGRHOLD and OVERPAID status) to ensure resolution and timely payment
• Educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes.
  
  

Qualifications

• Associates degree from an accredited university preferred
• Minimum of 3 years’ experience as a biller, collector, coder, or back office support staff
• Experience in an OB/GYN setting preferred but not required
• Knowledge of payer processes, local, state, and federal requirements
• Excellent written and oral communication skills
• Outstanding customer service skills
• Advanced knowledge of Microsoft Office
• Strong organizational, problem solving and decision-making skills
• Ability to prioritize and manage multiple projects and issues effectively and simultaneously
• Self-motivated and self-starter who can work well under minimal supervision
• Strong attention to detail, research and follow up skills
• Ability to work both independently and in a team setting
  
  

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