Revenue Cycle Specialist

Position Description – Revenue Cycle Specialist
POSITION TITLE: Revenue Cycle Specialist BOARD APPROVED: 12/15/2021
REPORTS TO: Chief Financial Officer (CFO)
DUAL SUPERVISOR PERSONNEL COLLABORATOR: Chief Executive Officer (CEO)
DIVISION: Administration
EXEMPT/NON-EXEMPT STATUS: Non-exempt
SECURITY ROLES: Billing and Finance


JOB SUMMARY: Analyzes revenue cycle data to assist HOPE and the contracted third-party billing company in revenue management. Proactively monitors revenue cycle performance, identifies areas of improvement and provides actionable work plans and recommendations. Responsible for effectively communicating with all staff to assure an overall efficient and effective revenue process. This includes monitoring of all charges, claims, payment posting, refunds, adjustments, denial follow-up, Accounts Receivable management, and reporting.


PRIMARY DUTIES AND RESPONSIBILITIES:
A. Monitors Billing System Transactions to ensure patients accounts are maintained in an effective, efficient and accurate manner.
B. Serves as the main liaison between HOPE and the third-party billing company.
C. Work with billing and other departments to insure appropriate and timely follow up and resolution to issues that are stopping the revenue cycle process and cash flow.
D. Answers billing questions from patients, staff, and billing company taking into consideration allowable and Medicare guidelines.
E. Develops and maintains proper procedures for billing and collections in order to maintain a low AR account balance.
F. Manages and monitors commercial insurance, Medicare, Medicaid, and Self Pay accounts.
G. Maintains reports by tracking billings, monitoring collections, and compiling information.
H. Maintains work operations by following policies and procedures and reporting compliance issues.
I. Maintains quality results by following standards.
J. Protects HOPE's value by keeping collection information confidential.
K. Updates job knowledge by participating in educational opportunities.
L. Serves and protects HOPE by adhering to professional standards, policies and procedures, federal, state, and local requirements standards.
M. Enhances billing department and HOPE’s reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
N. Ensures that all services are coded and entered into the Electronic Health Record (EHR) system accurately and in a timely manner by the billing company, consistent with established practice policies and procedures.
O. Responds to patient phone calls on insurance or payment problems and issues.
P. Meets with the billing company and the CFO on a regular basis to discuss the status of Accounts Receivable and collection issues.
Q. Escalates delinquent and complex claims to the billing company for further guidance.
R. Follows Medicare rules and regulations and updates billing and collection procedures to accommodate changes.
S. Stays current with insurance contract rates and policy changes.
T. Utilizes summary reports to confirm accuracy of data input and makes corrections as needed.
U. Manages Revenue Cycle and third-party billing staff to ensure timely processing of charges.
V. Ensures that account aging balances are kept within acceptable collection standards.
Y. Performs administrative support duties to ensure accurate and efficient office operations
Z. Maintains proper procedures for sliding fee scales and fee schedules.
AA. Reviews poverty guidelines, sliding fee scales, and fee schedules for board approval on an annual basis
BB. Assists Administrative Team on any type of reporting needed regarding patients and providers accounts history.
CC. Assists CFO with preparation of monthly reports and other tasks as requested. DD.Develops and maintains proper ways of communication between HOPE and the third-
party billing company.
EE. Ensures the third-party billing company has the appropriate level of access to HOPE’s EHR.
FF. Develops and maintains credentialing paperwork for newly hired providers.
GG. Assists the credentialing specialist at the third-party billing company with credentialing & re-credentialing of providers at HOPE.
HH.Promotes a team-oriented atmosphere and takes initiative in maintaining a tidy environment.
II. Serves as a Billing Liaison between the Receptionists and Clinical Staff
JJ. Develops and maintains proper procedures for the front desk staff according to policies and procedures.
KK. Develops new tools and trains front desk staff to make sure everyone follows the same guidelines.
LL. Trains staff on proof of income and develops a consistent audit process for verification of charges.
MM. Ensures front desk staff is well trained and understands all patient services procedures and recommends proper disciplinary actions if processes are not followed consistently.
NN. Researches and recommends needed staffing and/or contract services for billing, coding, and patient financial services staff in accordance with budgetary guidelines.
OO. Works with accounting to provide information necessary to generate financial statements and to accomplish fiscal audits and reimbursement studies.


INTERMITTENT DUTIES:
A. Other duties as assigned by supervisor

.
OFF-SITE WORK:
Off-site work is both required and allowed for this position.
A. Required Off-Site Work: May frequently be required to attend meetings, conferences, and other events which occur off-site, or to respond to urgent administrative or clinical issues while off-site.
B. Allowed or Optional Off-Site Work: Allowed to work off-site as needed if the work can be completed more efficiently in an alternate location. Any Optional Off-Site Work must be pre-approved as the direct supervisor deems necessary.


SKILLS/QUALIFICATIONS:
A. Administrative Writing Skills, Organization, Data Entry Skills, General Math Skills, Financial Software, Analyzing Information, Attention to Detail, Thoroughness, Reporting Research Results, Verbal Communication, Legal Compliance, Quality Focus, Productivity, Time Management, Organization, Documentation Skills, and Resolving Conflict.
B. Minimum 2 years billing experience in a medical office setting. Multi-specialty practice preferred. High level of competency with computers, the Internet, and computer software such as MS Office or equivalent is required. Demonstrated knowledge of medical office operations, professional fee billing, third party payer regulation and medical billing software experience is required.
C. Proficient knowledge of medical terminology; ICD-10 and CPT codes. Working knowledge of regulatory requirements pertaining to health care operations and their impact on practice operations. Ability to work, plan, research and conduct projects with minimal supervision. Ability to organize and prioritize workload to manage multiple tasks and meet deadlines. Superior verbal, written, organizational, and interpersonal skills are required. The ability to work with staff at all organizational levels, particularly peers, team members, other departments is required.


PERSONAL ATTRIBUTES:
A. Must maintain strict confidentiality in performing the duties of the Billing Director; also demonstrate the following personal attributes: be honest, trustworthy, and respectful, possess cultural awareness and sensitivity, be flexible, and demonstrate sound work ethics.


WORKING CONDITIONS
A. This position will spend long hours sitting, using office equipment and computers, and occasionally doing some lifting of supplies and materials, which can cause muscle strain. Must meet with others on a regular basis. Could spend long hours in intense concentration on the computer entering financial information, which requires attention to detail and high levels of accuracy. There are several deadlines associated with this position, which may cause significant stress.


This job description is in compliance with the Americans with Disabilities Act (ADA) and the Fair Labor Standards Act (FLSA) (May 1995)


HOPE Family Health Services is an equal opportunity employer who complies with applicable State and Federal civil rights laws and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran or disability status.

 

Many positions at HOPE Family Health Services are funded in-part or in-whole by State or Federal Department of Health and Human Services funding and as such, our organization cannot employ individuals with certain criminal backgrounds or who are on State or Federal exclusion or debarment lists.

If you are interested in applying for a position below please download the online application,

 fill it out COMPLETELY and ACCURATELY, then submit it to the health center by emailing it,

along with your complete resume, to mirandaconnor@hopefamilyhealth.org

 

For more information | 615-644-2000 ext. 472
E-mail application and resume to Miranda Connor, Director of HR