Revenue Cycle Coordinator

General Statement of Duties:

The Revenue Cycle Coordinator performs verification of benefits, obtains authorizations, and manages the claims submission process in accordance with all state, federal and third-party payer contractual requirements.

Level of Responsibility:

Reports to

Controller Status:

Non-exempt, hourly; Full time

Pay Range:

Starting at $24.86/

HR Schedule:

Monday-Friday 8AM-4:30

PM Located:

In office in

Kearneysville, WV Duties and Responsibilities:

1.

• Verifies eligibility and benefits on all referred and admitted patients utilizing the EMR, clearinghouse, payer portals and phone calls to the insurance company 2.
• Resolves any issues with coverage at the time of admission which may include contacting the Benefits Coordination and/or the patient/family 3. Re-verifies insurance coverage monthly for all active patients 4. Maintains a thorough knowledge of third-party billing and authorization requirements. 5.
• Obtains authorizations as required by plan benefit on all insurance payers including Medicaid. 6.
• Obtains retro-authorizations or updates existing authorizations in a timely manner 7.
• Places claims without authorization on hold at the end of the month and release once authorization is obtained 8.
• Corrects date of death issues in the Medicare and Medicaid systems utilizing established policy and procedure that is in place that prevent claims from being paid 9.
• Checks the FISS system weekly to determine if an ADR or redetermination is posted. If so, print the notice and gives it to the Director of Quality and Compliance. Keeps the tracking sheet updated. 10.
• Processes and submits accurate claims to Medicare, Medicaid, private insurance, and other third-party payers. 11.
• Post insurance and patient payments to accounts, ensuring all payment transactions are accurately recorded. Manage payment adjustments and write-offs as necessary, ensuring all balances are accounted for. 12.
• Coordinates all balance-billing follow up, write offs following the write off policy, verifying agreed-upon payment schedules as needed, or pursues collections if instructed and maintains all billing records electronically.

13. Analyze discrepancies and collaborate with relevant departments to resolve any billing issues promptly. 14. Completes training with peers to ensure continuation of critical workflow during planned or unplanned staff absences. 15.

• Ensures fee schedules in EMR comply with annual Medicare and Medicaid rate changes and third-party contract terms.

16. Prepares and submits accurate billing to third party payers and self-pay invoices. 17. Identifies and resolves billing clearinghouse rejections. 18. Conduct root cause analysis on unpaid accounts receivable and resolves with third party payers. 19. Follows established policy for obtaining approval on adjusting account balances for bad debt write off. 20.

• Adheres to established billing and closing cycles 21.
• Establishes strong relationships with Nursing Homes to ensure transparent communication between the facilities.

Manage month-end West Virginia Medicaid Room & Board claims and ensure accuracy as to patient, facility, case mix, patient responsibility, and several other key fields. Maintains a comprehensive accounts receivable West Virginia Medicaid Nursing Home Room & Board listing to determine the appropriate liability accrual at month0end. Investigate and follow-up on all discrepancies with nursing home contacts. 22. Meets with Controller on a weekly basis to review work plan, progress, and strategies. 23. Preserves confidentiality of all company patient and fiscal information 24. Always represent the Company professionally. 25. Complies with Company policies, procedures, and standard practices. 26. Other duties as assigned. Denotes essential job functions

Education and Experience :

1. High School Diploma 2. Minimum three years of medical billing and collection experience required. 3. Hospice and/or home health experience preferred. 4. Knowledge of third-party billing and state and federal regulations preferred. 5. Ability to prioritize and multi-task independently with little supervision. 6. Must be self-motivated, service oriented and have excellent written and oral communication skills. 7. Requires typing and data entry skills with emphasis on accuracy.

Physical Qualifications:

1. Ability to communicate verbally and in writing in English language. 2. Ability to hear normal conversation in person and via phone. 3. Ability to read normal or condensed print.

Equipment Used:

Telephone, electronic equipment, office equipment.

Work Location:

In person