Revenue Cycle AR Claims Specialist

The responsibility of the Revenue Cycle Claims Specialist is to maintains current knowledge of insurance carriers’ rules, regulations, and contracts; acts as a liaison for patients with the insurance carrier for internal/external customers; and is responsible for posting payments, adjustments, status, and reason codes. Contracts are reviewed for accuracy of payment with direct communication with payer provider reps. Analyze and test new system modules and upgrades. Confirmed and maintains mandated requirements for provider rosters.

1. Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlined in the Service and Behavioral Standards document. To this end, employees will be expected to read, have familiarity with, and embrace the principles contained within.

2. Research and resolve claims based on assignment, which could include contacting payers via phone or website, contacting practices, working across departments, writing appeals, and facilitating their submission, and all other activities that lead to the successful adjudication of eligible claims.

• Provides medical record documentation to insurance companies as requested.
• File claims using all appropriate forms and attachments.
• Communicates with insurances companies about insurance claims, denials, appeals and payments.
• Research denied and improperly processed claims by contacting insurance companies to ensure proper processing and/or reprocessing of claims. Works directly with provider reps to escalate claims issues.
• Resubmits denied and improperly processed claims to insurance payers in a timely manner.
• Creates, reviews, and works insurance aging reports to identify unpaid insurance claims, correct any errors, and resubmit claims as needed to ensure timely and accurate payments are received.

• Task appropriate staff while working vouchers for denials, $0 pay, and refunds.
• Communicate with Practices and Payers regarding claim denials and payer trends.
• Research denied, delayed, and underpaid claims utilizing online payor portals.

3. Working with Practice Management and co-source model to keep files up to date and identify and seek support.

• Analyze and test new system modules and upgrades. Provide recommendations to management staff regarding modifications, education, and training.
• Collaborate with physician credentialing to satisfied insurance and governmental mandate on insurance roster every quarter.
• Maintaining and updating provider credentials and updating insurance category classification.

4. Monitor and execute work on assigned worklists, reports, projects, or team goals.

5. Meet productivity standards as set by management.

6. Demonstrate knowledge and understanding of insurance billing procedures as evidenced by the identification of root-causes of claim issues and proposed resolutions to ensure timely and appropriate payment.

7. Educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers, and others as necessary to ensure accurate processes.

8. Reporting and Research: Identify issues and/or trends and provide suggestions for resolution to management, including payer, system, or escalated account issues. Evaluate carrier and departmental information and determine data to be included in system tables.

1. Two (2) or more years of successful experience within medical billing office

2. Two (2) or more years of computer skills and PC experience, including word and Excel.

3. One (1) or more years of customer service experience

Knowledge and Skills: