POSITION RESPONSIBLITIES (THIS IS A NON-EXEMPT POSITION) |
- Responsible for identifying, analyzing, and managing Process Improvement projects in the Revenue Cycle area.
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- Responsible for working the Billing Work Queue impacting revenue for timely review and claims submission (Front/Back Office functions).
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- Monitor patient account details for billing related issues.
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- Reporting claims status to clients on a regular basis to ensure accurate communication between departments within a healthcare organization.
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- Knowledge of payer guidelines and policies.
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- Identify and communicate with Director of Patient Access/Office Managers of the front office trends impacting claims rejection/denials for training opportunities.
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- Provide support to RCM Manager, Coder, Site Office Managers and CBO Vendor in order to expedite claims payments.
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- Coordinating with other departments to ensure that billing cycles are completed efficiently.
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- Work the monthly and cumulative missing encounter report by validating open encounters are truly missing and working with the clinicians to ensure that they complete documentation and close encounter.
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- Access and navigating through various payer portals for claims reconsideration and processing.
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- Follow up on unpaid claims, appeals of denied claims and post payments/adjustments accordingly.
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- Review the closed encounters that appear on the missing encounter report to validate a charge filed in Transaction Inquiry.
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- Supports manager/supervisor in identification of potential loss revenue related to trends in charge entry, billing, coding, or contracting practices that are related to charge capture.
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- Utilize the coding resources to understand procedures that are denied.
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- Identify and communicate global payer issues with RCM, Managed Care and Back Office Vendor to generate evidence-based appeals for claims processing reconsiderations.
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- Understand Managed Care Contracts and various aspects of patient access to maximize claims reimbursement.
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- Monitor and review monthly Chronic Care Management invoices for Medicare reimbursement.
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- Responsible for receiving, tracking, and entering hospital encounters into Epic for billing reimbursement.
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- Export claims data from EHR into RCM Vendor portal for charge posting and billing.
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