Revenue Cycle Specialist, FT
United Surgical Partners International
- Atlanta, GA
- Permanent
- Full-time
- Generate and follow up on appeals where insurance has paid incorrectly Refile claims as needed to get claims to process for payment.
- Review denials and error messages in Zirmed and follow up promptly.
- Print the Advantx insurance aging reports weekly and review all accounts monthly.
- Call and check online for status of claims and documents in Advantx.
- Track and monitor any trending denials and notify BOM of common trends.
- Follow USPI policy which states to work each account every two weeks.
- Post all insurance comments in Advantx with detailed information on claim to include reps name, reference #, and phone numbers.
- Follow up on ALL insurance accounts and aging reports with collection status.
- Submit account adjustments weekly to BOM.
- Follow up on all correspondence within 24-48 hours, document using correct correspondence codes and file.
- Prepare Daily Deposit Log information for payment poster and BOM.
- Prepare and Mail patient statements.
- Familiar/working knowledge with the Revenue Cycle and maintaining financial buckets (90 days, 120 days, 150days) *Familiar/working knowledge with finding trending issues, Track and monitor why claims have not paid *Familiar/working knowledge with how managed care contracts are worked.
- Familiar/working knowledge of workers Comp or willingness to learn *Familiar/working knowledge of how to grammatical compose an appeal letter.
- Documenting accounts and consistent follow up on unpaid claims/accounts *Understanding insurance company policies and procedures and using this information as ammunition to "fight' for claims".
- Determining overpayments for insurance company and patients and preparing refunds *Understand how to determine allowed amounts for the procedure versus what was paid and what should be paid *Understanding all EOB's and the ability to explain to patients their financial responsibility *Generate and follow up on appeals where insurance has paid incorrectly Refile claims as needed to get claims to process for payment.
- Review denials and error messages in Zirmed/Waystar and follow up promptly *Follow up on ALL insurance accounts and aging reports with collection status.
- Ability to learn another function in the Business Office....cross training is mandatory *Two years experience in a doctor's office and or ASC/facility setting handling the revenue
- High School diploma or equivalent. One year of related experience and or training with ASC collections.
- Experience and or knowledge of Managed Care Contracts and the reimbursement of Workers Compensation entities.
- Understanding CPT, ICD-9, ICD-10 terminology.
- Basic math skills.
- Computer competency.
- Reasoning ability.
Required Experience:
- Employed at a doctor's office or ASC for minimum of 12 months
- Working Knowledge of Managed Care contracts and how they work
- Ability to verbalize the knowledge of Managed Care Contracts
- Working knowledge for manually calculating insurance allowed amounts and patient responsibility
- Working knowledge and comprehension of EOB's (Explanation of Benefits)
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