Revenue Cycle Specialist (Palliative Care)

Description

Revenue Cycle Specialist (Palliative Care)

SUMMARY  

Primarily responsible for generating billing, posting payments, and follow-up on claims to ensure timely payment.    

ESSENTIAL DUTIES AND RESPONSIBILITIES 

1. Review and balance month end visits. Assist in month end visit validation process and make necessary corrections. 

2. Generates patient claims through EMR billing system. Upload EMC file to clearinghouse as soon after target bill date and errors/holds are clear. Continue review of unsubmitted claims to avoid timely filing to the payers 

3. Responsible for all palliative care claims, Medicare, Medicaid, Commercial Insurance and Self-pay statements. Review claims prior to submission for compliance with Federal/State insurance regulations. Manage prebill held claims in compliance review. 

4. Auto/Manual post all palliative care payments and balance with daily deposits. Follow up on incorrect, partial payments or unpaid claims. 

5. Follow up on outstanding claims per aging report over 60 days. Documenting collection efforts in EMR. Submit appeals, when necessary, on denied claims. 

6. Submit write off requests with documentation after all collection efforts have been exhausted to the Department Director. 

7. Notifies Director of any problems with patients’ claims, or insurance companies 

8. Initiate projects with insurance provider rep. for specific claim/payment issues. Attend meeting with provider rep. to resolve ongoing and new issues. Maintain documentation to support efforts. File State Complaints when attempts with payor have been exhausted. 

9. Assist with data entry of referral/demographic information and charge entry when needed.   

10. Assists other Revenue Cycle Specialist as needed to meet department goals 

11. Other duties may also be assigned.  

Requirements

EDUCATION and/or EXPERIENCE 

High School Diploma, with some classes or continuing education in bookkeeping or accounting. Three to five years’ experience, using computer-based applications, or equivalent combination of education and experience. Proficient in Microsoft Office.

CERTIFICATES, LICENSES, REGISTRATIONS

If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law.