Revenue Cycle Specialist II

Weseekto grow our Insurance Collections Team concentrating on Special Projects. This role’s responsibility is to seek out and maximize reimbursement from various insurance plans by resolving complicated denials, short payments, billing errors, and other claim issues. The ideal candidate is a self-motivated individual that demonstrates strong critical thinking skills and can resolve complex problems with little leadership guidance or intervention. Individuals who excel in this role are ambitious, results-driven, and robust in root cause analysis.

In addition, this position requires attention to detail, strong written and verbal communication skills, and the ability to work well as part of a fast-paced team.

This is a 100% remote position. All necessary equipment to be successful in this position will be provided.

• Work assigned lists of outstanding claim balances and patient accounts with multifaceted issues across different payers and patients
• Identify trends, conduct follow-up, and perform root cause analysis on unpaid and underpaid insurance claims across different payers
• Perform actions towards remediation of outstanding balances according to policy and procedure; including but not limited to in-depth research, appeals, rebilling, obtaining insurance authorizations or referrals, correcting coding, calling the payer or clinic, and utilizing payor portals
• Resolve issues related to a patient’s coordination of benefits (COB), demographic discrepancies, insurance eligibility or authorizations, and referrals as needed
• Address patient benefit-related denials, including phone verification of plan requirements, financial risk, as well as other factors that may impact reimbursement
• Navigate through various payer systems, provider portals, and internal Company applications to ensure timely and accurate claim resolution
• Regularly calls payers, employers, and patients
• Demonstrate ability to build strategic business relationships with internal and external partners (i.e., Billing & Coding Team, Registration Department, Credit Department, clinical teammates, and the payer(s))
• Uses exceptional organization, written, and verbal communication skills to produce detailed documentation of research and actions taken on claims
• Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and Company policies
• Meet or exceed team metric expectations for production, quality, and adjustment accuracy

• High school Diploma or equivalent (w/ proof of documentation)
• Intermediate knowledge and skills in Microsoft Office tools;
  Excel, PowerPoint, Word, and Outlook
• Experience working in healthcare revenue cycle; emphasis on collections (2+ years)
• Ability to confidently place phone calls to payers, clinics and patients
• Preferred:
  Associate or bachelor’s degree
• Experience obtaining insurance authorizations and sorting out coordination of benefits –knowledge of retro authorizations and referrals is a plus!