Medical Billing Revenue Specialist

The position focuses on the tracking and reporting of patient account collection for a specialty medical practice.  This position includes daily tracking of financial information; cross support for charge entry, payment posting with an emphasis on maximizing patient satisfaction and profitability.   

Special Characteristics:   This position requires a comprehensive understanding of professional services reimbursement, account management in a healthcare setting, the practice currently uses the software platforms eClinicalWorks and HST.  This position requires a strong working knowledge of insurance carriers.  Also required is a strong working knowledge of CPT, coding and documentation guidelines.  Strong organizational and communication skills are essential for this position.  This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment.  Also required are general computer skills, typing skills and a working knowledge of Medicare Compliance, OSHA and HIPAA.
 
Essential Functions:  

1. Monthly Reporting and financial analysis. Reconcile the incoming tracking sheet deposits/ FinPak in accordance with practice protocol as required to ensure timely payment posting. 
2. Tracking provider insurance credentialing.
3. Managing MIPS-yearly changes to include fixing note, tracking progress and practice compliance.
4. Billing platform maintenance: eCW billing maintenance to include setting up new codes, eligibility set up for new insurances); Setting up new insurances; Updating fee schedules; Creating/updating claim adjustment codes; Creating/updating claim status; Assisting with streamlining of processes
5. Monitors all charges related to the assigned physician’s professional services into the practice management system in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction.  All charge batches should balance in both number of procedures and total dollar prior to posting.
6. Post all payments, by line-item, received for physician’s professional services into the practice management system including co-payments, insurance payments, and patient payments in accordance with practice protocol with an emphasis on accuracy to ensure maximum patient satisfaction and profitability.  All payment batches must be balanced in both their dollar value of payments and adjustments prior to posting.
7. Post all credit and debit adjustments to patient accounts with strict adherence to the guidelines.
8. Review the physician’s coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement.
9. Follow-up on all outstanding insurance claims 60-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability.   
10. Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians, managers and subordinates.
11. Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction.
12. Maintain knowledge of current issues regarding accounts receivable, Medicare Compliance and HIPAA.
13. Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates.
14. Proficiency with all facets of the medical practice management system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry.
15. Maintain an organized, efficient and professional work environment.
16. Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance. 
17. Other duties as assigned.

Supervises:  This position has no supervisory responsibilities but works with Billing Personnel Coordinator to communicate priorities related to the revenue cycle.
  
Education:  High school diploma or GED is required.  A college degree is preferred.     
Experience:   Requires a minimum of 5 years of accounts receivable experience in a medical setting. 
Skills:

1. Requires a high degree of organization
2. The jobholder must demonstrate current competencies applicable to the job position.
3. Requires excellent written and verbal communication skills
4. Requires strong basic mathematical skills.
5. Requires an extensive working knowledge of managed care networks and insurance carriers.
6. Requires an extensive working knowledge of accounts receivable functions including CPT   coding.
7. Requires proficiency in working with a PC, the Internet, and MS Windows. 
8. Requires a good understanding of the current Medicare Compliance, OSHA, and HIPAA regulations. 

Abilities:

1. Ability to establish/maintain cooperative working relationships with staff and providers.
2. Ability to communicate effectively and in a professional manner with all staff, managers and physicians.
3. Ability to prioritize and multi-task.

Physical and Mental Demands:  

1. Combination of sitting, standing, bending, light lifting and walking.
2. Requires a full range of body motion including manual and finger dexterity and hand-eye coordination.
3. Requires corrected vision and hearing to a normal range.
4. Requires the ability to manage stressful situations.
5. Occasional stress from varying demands.

Other Requirements:

1. Restriction of personal phone calls to break and lunch periods.
2. Attendance at monthly all staff meetings.
3. Adherence to practice policies, procedures and protocol.