Revenue Cycle Specialist

Position Summary

The Revenue Cycle Specialist is responsible for managing the revenue cycle processes to ensure timely, accurate, and compliant reimbursement for hospice services, with a primary focus on Medicare Part A billing and collections. This position oversees claims submission, payment posting, accounts receivable follow‑up, denial management, and appeals while ensuring compliance with Centers for Medicare & Medicaid Services (CMS) regulations and organizational policies.

Reports to:

Controller
Supervises:
None
Interpersonal relationships include all interactions with patients, family members, physicians, referral sources, visitors, co‑workers, and others. These interactions must be courteous, respectful, cooperative, and professional, fostering teamwork and positive relations.

• Manage the complete Medicare Part A revenue cycle, including notice of election processing, billing, payment posting, accounts receivable follow‑up, and reimbursement reconciliation.
• File Notices of Election (NOEs/81A) timely and accurately, review the Medicare Common Working File (CWF), and verify Medicare eligibility, certification periods, benefit days, and primary payer status.
• Coordinate monthly billing activities with Nursing, Clinical, and Administrative staff to ensure accurate and timely billing for all payers, with emphasis on Medicare Part A reimbursement.
• Perform pre‑billing quality assurance reviews using established month‑end accounts receivable checklists to ensure billing accuracy and compliance.
• Generate, review, and submit primary and secondary claims for Medicare Part A and other payers in accordance with CMS billing guidelines.
• Monitor claim status, research claim edits and rejections, resolve billing issues, and resubmit corrected claims to ensure timely reimbursement.
• Utilize Direct Data Entry (DDE), Medicare systems, clearinghouses, and other payer portals to research claim status and resolve outstanding accounts receivable.
• Prepare and process claim corrections, retroactive billing adjustments, reopenings, reconsiderations, and appeals as necessary.
• Run retroactive change reports and generate or adjust claims based on changes affecting reimbursement.
• Post Medicare payments, contractual adjustments, and remittance advice (ERA/EOB) accurately within the patient accounting system, including hospice per diem and consulting physician payments.
• Process consulting physician invoices and ensure accurate billing and payment reconciliation throughout the month.
• Monitor accounts receivable aging reports, investigate outstanding balances, and perform timely follow‑up to maximize collections and reduce days in accounts receivable.
• Identify, investigate, and resolve denied, rejected, underpaid, or unpaid claims while documenting all account activity.
• Follow up on all services that have not been billed to ensure complete and timely claim submission.
• Bill charity care accounts in accordance with organizational policies and processes, approve charity write‑offs, and bad debt adjustments.
• Verify patient insurance eligibility, benefits, and Medicare entitlement and ensure all required documentation supports medical necessity and billing requirements.
• Ensure compliance with CMS regulations, Medicare Administrative Contractor (MAC) requirements, HIPAA, and organizational policies.
• Maintain current knowledge of Medicare Part A regulations, hospice billing requirements, reimbursement methodologies, and industry best practices.
• Monitor revenue cycle key performance indicators (KPIs), identify reimbursement trends, and recommend process improvements to enhance operational efficiency and reduce denials.
• Maintain complete and accurate patient financial records and supporting documentation in the electronic health record and billing systems.