High school diploma or GED required
The Revenue Cycle Billing & Denial Resolution Specialist is responsible to ensure all initial third party and federal/state government hospital claims are billed and all unpaid, rejected or denied claims receive appropriate follow up or an appeal to over-turn the denial as required. This position is responsible to accurately and timely prepare and submit all clean claims or corrected claims to payers via the claims scrubber both electronic (837) or paper. Take action required to resolve pre billing claim holds. Resolve rejected, underpaid and denied claims by submitting corrected claims and appeals on a timely basis upon review of unpaid encounters. The position is required to idenity and resolve complex claims issues adversely impacting the revenue cycle and achieve resolution through coordination with other Revenue Cycle departments, clinical departments and the payer with accurate and timely corection of all pending claims to payers.
EDUCATION, EXPERIENCE AND QUALIFICATIONS -
- High school diploma or GED required. Associate's degree in a related field preferred.
- Minimum of 2 or more years work experience with one or more of the following: third party claims billing, insurance follow up, denials management, underpayments, managed care contracts, cash application, credit resolution, audit, claims processing and revenue cycle compliance in a hospital, physician's, medical service organizations or health system revenue cycle department is preferred.
- Must have working knowledge and experience interpreting third party payer rules to include coordination of benefits, interpreting policy benefits, interpret contracts, state and federal regulations, overturning denials and underpayments and payment methodologies (DRG, case rates, revenue codes, fee for service) and remain current on all industry changes in billing requirements.
- Working knowledge of medical terminology, ICD9 & ICD10, HCPCS, CPT codes and revenue codes for billing is required.
- Organizational and time management skills and ability to work independently.
- Proficiency in computer keyboarding skills required.
- Ability to effectively gather and exchange information in both oral and written communications.
- Detail oriented, analytical skills, root cause analysis, ability to problem solve and recommend resolutions.
- Ability to use MS Office Suite (Word, Excel, Outlook) at an intermediate level.
- Ability to work independently with minimal supervision.
- Stays current on industry regulations and requirements.