Revenue Cycle Associate

Job Title: Revenue Cycle Associate

Reports To: Revenue Cycle Manager

Job Summary: The Revenue Cycle Associate/Patient Accounts maintains a highly professional environment, ensuring all Revenue Cycle (RC) processes are completed in a timely and accurate manor

Qualifications and Requirements:

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. This job description in no way implies that these are the only duties to be performed and may be modified, interpreted and/or applied in any way as necessary. Maintaining regular and punctual attendance is required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Essential Job Duties:

Payer AR

• Work all assigned payer tasking, which includes, but not limited to the following
• Submit appeals and/or reconciliation letters as needed for denials
• Address all non-payment transactions
• Submit any requested documentation to third party payers
• Make appropriate adjustments to patient accounts as directed by third party payers and related revenue cycle procedures
• Communicate with insurance companies as need to ensure timely claim processing
  • Attend trainings and meetings, internal and external, as applicable.

Patient AR

Investigate and gather appropriate information to ensure accuracy of patient account balance and demographic information

• Process and submit patient statements
• Post patient payments and adjust as necessary and related to revenue cycle procedures
• Assists patients to address questions regarding statement balances
• Setup and maintain budget plans
• Refer patients to CCHCI to Outreach and Enrollment to review state and federal financial assistance programs
• Run automated processes include SFDP, Unapplied credits and Auto Adjustment batches
• Work all assigned tasking
  • Attend trainings and meetings, internal and external, as applicable.
  • Payment Posting
• Process all third-party payments and lockbox correspondence
• Work all assigned tasking
• Provide accurate daily and end of month balancing
  • Attend trainings and meetings, internal and external, as applicable.

Charge Processing

• Process all charges from the holding tank daily
• Review charge accuracy prior to claim submission and address inaccuracies
• Run and correct all claim edits daily within NextGen and Clearinghouse
• Mail paper claims daily as needed
• Work all assigned tasking
  • Attend trainings and meetings, internal and external, as applicable.

Required Education, Experience, Certificates & Licenses:

• High School Diploma or GED.
• One-year experience in FQHC medical billing preferred.
• Any combination of experience and/or education that provides the necessary combination of skills.
• Participates in training and education programs to maintain professional competence and skills.
• Driver's License and Proof of Insurance may be required if requesting mileage reimbursement.
• Valid Fingerprint Clearance Card.

Required Language Skills:

• Ability to comprehend and compose effective instructions, correspondence and communications in English in both oral and written format.

Physical Requirements:

• Ability to occasionally exert enough force to move objects weighing up to 10 pounds.
• Ability to continuously remain in a stationary position.
• Ability to occasionally move about inside the workplace to access files, office machinery, etc.
• Possesses hand-eye coordination and manual dexterity necessary to constantly operate computer, telephone, and other office machinery.
• Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.
• Ability to discern the nature of sounds at a normal spoken volume.

Other Required Knowledge, Skills, and Abilities:

• Ability to add, subtract, multiply and divide in all measure, using whole numbers, common fractions and decimals.
• Ability to compute rate, ratio and percent.
• Ability to skillfully gather and analyze data.
• Ability to perform variety of assignments requiring independent judgment.
• Ability to deal with challenges involving one or more variables in routine situations.
• Knowledge of billing, medical records, health plans, and community health centers preferred.
• Advanced, specialized knowledge of medical codes and coding procedures.
• Thorough knowledge of ICD, CPT, and NDC codes.
• Knowledge of HIPAA and Corporate Compliance rules and regulations.
• Computer literacy required in Microsoft Office.
• Proficiency in Nextgen EHR software preferred.

Work Environment & Conditions:

• Work environment is usually typical of an administrative office setting with no substantial exposure to adverse environmental conditions.