Revenue cycle

POSITION SUMMARY

The HB Revenue Cycle Support Specialist is responsible for a wide variety of administrative duties, including the accurate and timely submissions of facility claims to the third-party payors.

In addition to claim submission, responsibilities include timely corrections of all assigned claim rejection and claim denial categories.

The HB Billing and Follow-Up Specialist I contacts third party payers appropriately if there is no response after claim submission.

The HB Billing and Follow-Up Specialist I ensures proper adjudication of all payable charges by the third party payor, bringing the insurance liability to a zero balance.

ACCOUNTABILITIES

1. Keep ProMedica’s mission, To improve your health and well-being , as the foundation of employment.

2. Demonstrate personally and foster a work environment that includes ProMedica Values; Compassion, Innovation, Teamwork, and Excellence.

3. Using various Patient Accounting and Claim Scrubbing software applications, such as Epic and Quadax, perform a variety of hospital billing and claim follow up activities to achieve maximum reimbursement for all billable services provided by the facility from the appropriate third party payor.

4. Contact patients for necessary information pertaining to registration, billing and collection.

5. Answer all written correspondence and phone inquiries from insurance companies, internal or external departments, local, state or federal agencies and / or patients / guarantors in a timely manner with professionalism and exceptional customer service.

6. Maintain a working knowledge of department billing and follow-up procedures and workflows, including system functionality and program logic as it applies to assistance in procedures and workflows.

7. Maintain elevated attention to detail by reviewing all work for completeness and accuracy in compliance with system quality assurance policies.

Complete billing and follow-up tasks meeting department QA standards as demonstrated on the monthly Key Performance Indicators (KPI).

8. Function as a team member to organize and prioritize responsibilities to complete daily work requirements :

a. Comply with changes in duties and assignments in a positive and cooperative manner.

b. Adjust to peaks in workload.

c. Demonstrate flexibility and adaptability to change.

d. Complete assignments in appropriate time frames.

e. Aid co-workers to ensure completion of all assigned duties as necessary.

f. Work in collaboration with team to ensure prioritized daily tasks are completed when team members are absent, both planned and unplanned.

g. Perform duties in a self-directed manner with minimal supervision or direction.

9. Take ownership of identified issues, including internal and external customer service issues. Ensure the matter is resolved in a timely manner if able or escalate as appropriate with continued follow-up until resolution.

10. Provide feedback to leadership staff and / or Quality Assurance (QA) staff on issues that impede timeliness or quality and work with the appropriate personnel to resolve such issues.

11. Accountable for meeting individual and team designated KPI goals and deadlines.

12. Complete assigned special projects in a timely and efficient manner.

13. Actively participate in generating ideas for continuous optimization and automation solutions.

14. Keep abreast of in scope third party payor(s)’s billing, reimbursement and medical policies. Review in scope payer’s provider communication distributions, including registering for payer’s ListServe, for relevant updates and notifications.

Notify leadership of identified payor updates that apply to ProMedica’s billing and follow-up procedures.

15. Keep fluent with in scope payer’s provider billing manual.

16. Attend mandatory team and departmental meetings both on-site and virtual.

17. Complete all assigned continuing education courses. HBI, Healthstream.

a. Maintain current knowledge of Microsoft Office Application Suite. Self-assign training courses as needed. Including but not limited to Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft Teams and Microsoft OneNote.

18. Perform all other duties as assigned.

Job Requirements

Education : High School Diploma; OR Equivalent. Preferred : College Degree

Skills : Must demonstrate the ability to accurately and independently solve problems by taking a basic skills test and scoring a minimum of 80%.

ADDITIONAL EXPERIENCE

Must demonstrate creative problem-solving skills.

Must demonstrate excellent communication and interpersonal skills.

Must demonstrate excellent computer skills with Microsoft Office 365 Experience.

Must be able to move about office and between workstations while on-site.

Must interact virtually with team, clients and / or patients.

Must demonstrate commitment to exceptional customer service.

Must have strong organizational skills and the ability to multi-task.

Must be a team player and be supportive of our department and ProMedica mission and values.

Must be able to work independently, demonstrate the ability to manage large volumes of work, quickly learn and retain information.

WORKING CONDITIONS

Physical Demands : Basic office environment

ProMedica

Last updated : 2024-06-14