Revenue Cycle Administrator

Description

Our Mission is to provide compassionate care and services to empower individuals experiencing substance use disorders, mental illnesses, and homelessness to attain an enhanced quality of life regardless of ability to pay.

Position Profile: The Revenue Cycle Administrator will bill and collect payment on a timely basis for agency programs and maintain accurate records of billing, payments, and adjustments to accounts in billing computer systems. Additionally, this position will develop and manage the business processes and support services required to proactively manage payor contracts, all associated payor data, as well as credentialing and re-credentialing with commercial health plans. Ensure all activities comply with legal and regulatory requirements, including patient confidentiality and data privacy.

Essential Functions and Responsibilities: 

• Manages adherence to the contract initiation and contract renewal process including, but not limited to approval compliance      with preferred, acceptable, discouraged, unacceptable (PADU); accurate payer set up; accurate payer profile/database set up; and timely and accurate contract summary.
• Ensures proactive notification to internal stakeholders about updates to educational tools regarding participation in plans, commercial insurance contracts, and worker’s compensation programs.
• Educates relevant internal finance and operations teams about payor policy and procedure, process and/or other contractual      requirements to ensure compliance with the contract and to maximize revenue realization.
• Proactively manages credentialing and re-credentialing to ensure no disruption in network participation status,      including sending/maintaining/confirming timely and complete roster/demographic payor updates.
• Proactively monitors updates with payors (newsletters, portals, press releases) to mitigate risks and/or inform business of changes. Manage relationships with payors, and other third parties in order to enhance payor relationships.

Provider Credentialing:

• Maintain credentialing databases and online systems by ensuring availability of all necessary documents. Maintain copies of      current state licenses, DEA certificates, malpractice/liability coverage, and any other required credentialing documents for all providers.
• Compile and maintain current and accurate data for all providers; maintain confidentiality of provider information.
• Complete and process provider credentialing and re-credentialing applications; monitor applications and follow-up as      needed. Provide updates regarding changes in contracts/policies.
• Gather provider data for new contracts and submit information to the insurance company along with letters of intent, etc.      Update practice and provider information as necessary.
• With Human Resources, track license and certification expirations for all providers to ensure timely renewals.
• Demonstrate high emotional intelligence and maintain effective working relationships with providers, management, staff, and      contracts outside the organization, including MaineCare and Gainwell staff.

Patient Intake/Registration Functions:

• Manages Authorizations for programs.
• Utilizes portals, fax, and phone to accomplish tasks.
• Understands authorization process.
• Supports the training of new admission staff in billing insurance data entry processes and provides follow-up coaching and      review.

Insurance and Patient Billing:

• Files Claims with all contracted payors on schedule.
• Follow-up/claim corrections/appeals.
• Provides Invoices to Sliding Fee Clients and attempts collection.
• Provides income posting information to accounting staff.
• Manages assigned non-Medicare payor functions include but not limited to the following:
  • Unbilled review.
  • Follow-up/Claim corrections/appeals.
  • Cash posting.
• Manages all medical billing data for Director of Finance & Administration (DAF).
• Is knowledgeable about how payer structure and reimbursement is set up.
• Maintains billing files in computer and assures integrity of data.
• Ensures charges and cash are entered and posted in a timely and coordinated fashion for all payers.
• Maintains relationships with Leadership, Clinicians,  and Peers to assure accurate & timely receipt of billing information.
• Processes, balances, and transfers billing  information and accounts receivable reports as appropriate.
• Manages specific accounts receivable payment sources to ensure patient accounts are collected on a timely basis; including      management of patient accounts in terms of timeliness of information, processing bills and payments for monthly closing.
• Follows up overdue accounts according to departmental practice/policy and discusses collection problems with DAF.
• Maintains data to assist in provision management information reporting for organization.

Requirements

Qualifications Required: Bachelor’s degree and 3-5 years’ billing experience in a healthcare setting utilizing automated processes to manage accounts receivable. Certified Provider Credentialing Specialist (CPSC) certification/licensure preferred. 

Physical demands and work environment: Freedom of movement on a regular basis. Operating basic office equipment in a normal office environment. May spend extended periods operating a desktop computer, requiring hand-eye coordination and finger dexterity; physical activity requires walking, bending, standing and lifting.