Revenue Cycle Specialist (FT)

-EDUCATION (must be required for position), LICENSE, CERTIFICATION and

EXPERIENCE

Education:

High School Diploma, or GED preferred.

Licenses:

No professional license required.

Certifications:

No certifications required

Experience:

Minimum of 2-3 years of experience in medical billing, coding, or revenue cycle management. Experience in a healthcare setting is preferred.

REQUIRED SCREENINGS

Drug Screen Physical Assessment Tuberculosis screen Background check (Criminal, Civil, Educational, Previous Employment, etc.) Driver Record screen (positions requiring on-the-job driving)

ESSENTIAL FUNCTIONS

GENERAL DUTIES:

• Reliable and punctual attendance is essential; expected to be at job as scheduled each scheduled day.

Billing:

Process patient accounts, ensuring that all charges for medical services are billed accurately and in accordance with healthcare regulations. Working with coding for accuracy and completeness.

Insurance Verification & Authorization:

Verify insurance coverage for patients, ensuring that required authorizations and referrals are obtained for services.

Claims Management:

Submit insurance claims in a timely manner, following proper coding and billing protocols. Ensure compliance with insurance guidelines and address any rejections/denials promptly.

Payment Reconciliation:

Reconcile payments and resolve discrepancies between payments and charges.

Denial Management:

Investigate denied claims, working with insurance carriers and patients to resolve issues. Follow up on unpaid or underpaid claims to ensure timely reimbursement. Document all actions taken for future reference.

Patient Billing &Customer Service:

Assist patients with billing inquiries, ensuring that they understand charges, insurance payments, and balances. Provide support for payment plans or financial assistance programs if necessary.

Compliance & Documentation:

Maintain up-to-date knowledge of insurance policies, billing codes, healthcare regulations, and compliance requirements to ensure accurate and legal billing practices.

Collaboration:

Work closely with other departments such as clinical staff, coding, and finance teams to ensure proper documentation and smooth workflow throughout the revenue cycle.

GENERAL SKILLS

• Strong attention to detail with a high level of accuracy.
• Knowledge of healthcare billing standards using (ICD-10, CPT, HCPCS).
• Familiarity with insurance verification, claims submission, and denial management..
• Proficiency in using healthcare management software (e.g., Epic, Cerner, PCIS,ECW). (Preferred, but not required)
• Strong communication skills, both verbal and written, for patient interactions and collaboration with internal teams.
• Attention to detail and accuracy in processing billing and claims.
• Ability to communicate effectively with insurance companies, patients, and internal teams.
• Knowledge of HIPAA regulations and healthcare compliance

ORGANIZATIONAL EXPECTATIONS

• Be responsible for my own attitude.
• Be open to constructive feedback and suggestions for improvement; accept constructive feedback in a positive manner.
• Be generous with my skills and abilities by educating others on new ideas and/or techniques; offer constructive input to support the work area appropriately and respectfully.
• Take responsibility to attend or obtain information provided at in-services, seminars and staff meetings.
• Demonstrate, through my actions and speech, that I represent the entire organization. I will take action to ensure that a need is met; emulate the mission and vision statements.
• Acknowledge and greet everyone; look approachable, with open body posture, eye contact and a smile; communicate appropriately using good interpersonal skills.
• Dress professionally and appropriately for my work environment.
• Know and follow policies and procedures for both organization and department safety issues.
• Communicate delays in services and take service recovery steps as needed.

WAGE starts at $18.37 per hour and goes up based on experience Immunizations required for employment FHW offers a full benefits package including:

FOR ALL EMPLOYEES

: Employee Assistance Program 403 (B) with 4% match from FHW and zero day vesting schedule

FOR FULL TIME EMPLOYEES WORKING AT LEAST 30 HOURS A WEEK

Medical Plan Options:

PPO plan with copay/coinsurance and lower deductible High Deductible Health Plan with the option for a Health Savings Account. Telemedicine includes in both plan options. Dental Vision Life Insurance/ Accidental Death and Dismemberment Insurance Disability Insurance with a Short and Long Term Option.

Critical Illness and Accident Plans Cafeteria Options:

Health Reimbursement/ Flex Savings A host of other options to include: Pet Insurance, Identity Protection, Travel protection, etc.