Job Summary

Review and process claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for assigned clients.

Major Responsibilities/Activities

• Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance
• Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff
• Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues
• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim
• Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion
• Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs
• Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though
• Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved
• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness
• Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs
• Conduct all job tasks, calls, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations
• Consistently support and demonstrate the company mission and values

Other Responsibilities/Activities

• Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager
• Serve as backup to other teams members as required
• Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist or Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager

Requirements

Performance Requirements

• Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service Level Agreements, A/R Aging, Net Collection Percentages, Average Cash Per Trip, Denials, Rejections, Account Review Aging, and maintaining a 96% audit score monthly.

Required Education, Skills, & Experience

• High School Diploma
• At least 1-2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience
• Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though
• Ability to organize, prioritize and multi-task
• Ability to learn, understand, and work within specific compliance, client, and payer requirements
• Approach all tasks, duties, and interactions with an attitude of continuous improvement
• Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties
• Ability to function well within a cross-functional team setting and independently
• Detail-oriented
• Resourceful
• Self-starter
• Must possess critical thinking/analytical skills
• Proficient in Microsoft Office programs

Preferred Education, Skills, & Experience

• Strong preference for prior EMS billing and/or denials experience
• Proficient in EMS|MC billing software

Working Environment/Physical Requirements

• General office environment
• Frequent typing
• Sitting, standing, walking
• Use of basic office equipment such as computer, fax, printer, copier, and telephone

*Please note, our hiring process typically lasts 2-4 weeks with three to four interviews total.*