Revenue Cycle Specialist - Business Office

Monday through Friday 8:00 a.m. to 5:00 p.m.

$16.50 - $22.10 per hour / DOE

JOB PURPOSE:   The Revenue Cycle Specialist as part of a team is responsible for performing at a specialist level administrative and fiscal duties, tasks, and assignments in support of the Business Office Department and its varied operations. The  Revenue Cycle Specialist will assist in optimizing the department’s workflow and processes out of the EPIC Electronic Health Record (EHR) system and must be knowledgeable of the organization’s policies, procedures, and business operations. The Revenue Cycle Specialist working closely with management and other revenue cycle paraprofessionals completing recurring administrative revenue cycle duties and tasks, managing cash inflow activities for the organization, as well as supporting resolution of obstacles to billing. The Revenue Cycle Specialist serves as a conduit to identify business partner issues such as disputes with customers and summarizes information so that issues can be resolved. Responding to requests for information, records, and supports the facilitation of billing services and functions, while interfacing with multiple systems, online resources, and software programs. The Revenue Cycle Specialist may work in either a medical receivable or a dental receivable assignment, at a location assigned by management. Performing the functions and requirements for this position follows standardized procedures and policies requiring minimal judgment in their execution and will always remain within the defined scope for the

position.

The Revenue Cycle Specialist works with intermittent supervision and review, and any work problems involving.

departures from standard policies, interpretations, or procedures are presented to the supervisor for resolution.

Essential Job Functions:

• Performs administrative, technical, and fiscal duties, tasks, and assignments supporting Business Office

operations within established periods; meeting established rates of performance for the quality and

quantity of work for the position; demonstrating a level of quality, efficiency, and accuracy in the

employee’s job performance that ensures the highest standards of excellence.

• Maintains at all times patient confidentiality by controlling the information being disclosed to authorized.

individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as accepted.

confidentiality standards.

• Participates in meetings with third-party payers to resolve contractual discrepancies or payment issues when needed/requested.
• Responsible for creating and completing system tasks related to revenue cycle elements including, but

not limited to evaluating accuracy of patient financial information, insurance eligibility, verifying covered

• services via online and direct communication with health plan representatives and managing appeals.

and claims follow-up.

• Responsible for communicating observed payment trends, non-payment and/or incorrect payments to the

management team.

• Advocates and educates patients and providers regarding billing concerns and responsible for establishing patient payment plans.
• Under supervision, researches, reviews, interprets, and processes healthcare services and claims in

order to support accurate patient account and payer balances, applying correct account adjustments.

based on current CPT, regulatory, and payer specific billing rules.

•  Maintains accurate and current information on patient account and payer balances by posting.

third-party and patient payments, adjustment, or denials.

• Obtains and maintains accurate information on patient financial responsibility by verifying patient.

insurance coverage and eligibility; obtains proper medical releases as required.

• Supports the continual improvement of the revenue cycle by assisting management and other.

colleagues on projects; provides feedback on processes and newly implemented changes in

order to achieve continued process improvement.

• Responsible for completing system tasks and processing related to revenue cycle elements, such as:
•  Evaluating the accuracy of patient financial information.
•  Managing the resubmission processing of claims.
• Responsible for communicating observed payment trends, non-payment and/or incorrect payments to the management team.
• Completes assigned projects in coordination with management.
• Embraces and supports a professional working environment based upon an understanding and respect.

for diversity and multi-culture in all its forms; demonstrates sensitivity, acknowledges varied beliefs,

attitudes, behaviors, and customs; and encourages communication and appreciation of all forms of

diversity.

• Demonstrates an exceptional level of customer service, answering and responding to all incoming calls,

emails, and inquiries in a timely and effective manner, responds to requests for support providing general.

information in response to inquiries; referring technical inquiries or complaints to the appropriate

department member for resolution.

o Exemplifies “World Class” customer service experience working to resolve complaints and living

    the mission, vision, and values of the organization.

• Communicates effectively through written, verbal, and interpersonal skills as applied when interacting with

employees, internal/external clients or representatives, or patients, successfully conveying and

exchanging information in a positive and effective manner.

 Ensures accurate information is maintained for patient accounts and payer balances by posting third party and patient payments, adjustments/denials, and reclassifying charges to correct payers.

• Demonstrates a higher level of attention to detail, and lower error rate in the employee’s work, ensuring.

that required and entered information is accurate and payer balances are included in patient accounts.

and payer accounts by completing data-entry posting and processing requirements.

• Gains and maintains an understanding of International Classification of Diseases (ICD) and Current

Procedural Terminology (CPT) coding.

• Gains and maintains a general understanding of applicable Federal, State, and commercial payer.

requirements, standards, regulations, or laws; as well as all organizational policies and procedures related.

to healthcare billing and payment processing.

o to include, the standards and requirements for commercial and managed care insurance

governmental regulations; and commercial or managed care insurance guidelines regarding         billing, documentation, and compliance.

• Attends and participates in conferences, workshops, and other training opportunities related to

receivables billing, coding, and corporate compliance standards, or regulations.

• Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.
• Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.

Minimum Education and Experience:

• High School Diploma or General Education Diploma (G.E.D).
• Three (3) years’ experience working in a medical or dental account receivables or claims examination role in a healthcare environment.

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Required Licenses, Certifications, and Registrations

• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

Preferred Education, Experience, Skills, Abilities:

• Five (5) years’ experience working in medical or dental account receivables or claims examination role in a healthcare environment.
• Coding certification preferred.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

El Rio Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

All employees are required to undergo drug testing prior to employment and, will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

El Rio Health is a Non-profit 501 (c3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards.