Revenue Cycle Support Specialist

POSITION TITLE: Revenue Cycle Support Specialist

RESPONSIBLE TO: Revenue Cycle Manager 

FLSA STATUS: Non – Exempt 

Purpose of the Position: The Revenue Cycle Support Specialist provides operational support across Revenue Cycle, Front Office, and Credentialing functions to ensure efficient patient access, billing operations, and provider enrollment activities. 

QUALIFICATIONS:

1. High School diploma or GED is required; Associate Degree in Business Administration, Healthcare Administration, or related field preferred.
2. Minimum two years of experience in healthcare administration, medical office operations, medical billing and customer service, credentialing, or related healthcare experience setting.
3. Knowledge of medical insurance plans including Medicare, Medicaid, commercial insurance, and managed care organizations.
4. Knowledge of and experience working with insurance enrollment systems including PECOS and CAQH is preferred.
5. Knowledge of and experience working with Epic preferred.
6. Knowledge of FQHC billing practices including PPS and wraparound claims preferred.
7. Knowledge of computers and computer systems including Microsoft Applications.
8. Knowledge of HIPAA regulations and healthcare confidentiality requirements.

RESPONSIBILITIES:

Revenue Cycle:

1. Respond promptly and professionally to customer service inquiries via phone and portal.
2. Research and resolve basic billing, payment, and account concerns.
3. Manage incoming mail and return mail.
4. Collaborate with internal staff and external contractor to resolve billing and customer service issues.
5. Utilize Electronic Health Record (EHR) system to update patient information, process billing data, and support provider and staff needs.
6. Maintain accurate documentation of all interactions and resolutions in compliance with organizational policies.

Credentialing:

1. Collaborate with providers, internal staff and external contractors, on all enrollment, credentialing and provider contracting.
2. Act as primary point of contact for external contractor and operations team for initial provider onboarding.
3. Support CAQH profile management and ensure provider information remains current and accurate.
4. Maintain current knowledge of all verification procedures, data entry procedures and report development and production.
5. Process and track provider terminations and disenrollment.
6. Utilize advanced problem-solving skills to resolve issues and conflicts that may arise.
7. Maintain confidentiality of provider information and comply with regulatory policies and procedures.

Front Office Operations Support:

• Provide support and education regarding registration, scheduling, insurance verification, eligibility, and sliding fee processes.
• Provide support, education and validation via audit of the sliding fee discount program.
• Provide support and education regarding new VFHC revenue initiatives.

Perform other duties as assigned.  

Physical Requirements: 

1. Must be able to lift 25 lbs.
2. Continuous sitting, standing, walking.
3. Correctable vision and hearing.
4. The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.
5. The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation.