Revenue Cycle Specialist

Responsible for updating patient Billing Episodes and crediting account, as appropriate. Review and resolve prior authorization/precertification/referral issues, and contact insurance carriers to verify/validate requirements. Validates all necessary referrals/prior authorizations/pre-certifications for scheduled services are on file. Ensure all account activity is documented in the appropriate system and shared with all appropriate staff. Clinic Emails – responsible for managing clinic emails throughout the day. Identify, Correct and forward potential reimbursement problems to Revenue Cycle Manager. Responsible for billing all patient claims in a timely manner. Review claims issues make corrections as needed and rebill. Utilize claims clearinghouse, EMRs and payor portals to review and correct claims and to resubmit electronically when available. Responsible for evaluating bill cycles and changing/updating when necessary. Responsible for printing daily billing reports. Monitor validation percent. Work daily claims rejection lists. Gathers and interprets data from the system and understands appropriate courses of action to take and initiates time-sensitive and strategic steps resulting in payment. Call and status outstanding claims with third party payors. Review explanation of benefits to ascertain that claim processed and paid correctly. Document account follow-up where appropriate. Identify trends and work with the Revenue Cycle Manager for resolution. Perform other duties as assigned.