Revenue Cycle Associate

PN Financial Services
Full Time
Day Shift
8-5

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bedteachinghospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care.

Consistently ranked as bestin the Columbia Metroarea by U.S. News & World Report, Lexington Health delivers more than 4,000babies each year, performs more than 34,000surgeries annually and isthe region's third largest employer.

Lexington Health also includes an accredited Cancer Center of Excellence, the state’s first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer’s care center.

Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

To comply with and master all Government, Non-Government, and Third Party Payer regulations and contracts and to interpret these regulations to submit for processing and collect patient account balances. Interprets and applies compliance guidelines and in an effort to maintain billing integrity and reports any fraudulent or abusive practices to supervisor or other appropriate person (Compliance Officer, Supervisor, Manager, etc.). Comply and master an understanding of physician billing for each specialty type (Surgery, Oncology, Podiatry, Rheumatology, Family Medicine, etc).

• Minimum Education:
  
  High School Diploma or Equivalent
• Minimum Years of
  
  Experience:
  
  1
  
  Yearof experience in healthcare business office or physician office environment
• Substitutable
  
  Education & Experience:
  
  None.
• Required Certifications/Licensure:
  None.
• Required Training:
  Procedural knowledge of Medical/Medicaid and third party liability billing, reimbursement, and regulatory compliance;
  Procedural knowledge of account receivable management and understanding of entire revenue cycle.

• Responsible for compliance with applicable payer policies, guidelines and regulations. Requires frequent contact with payers and insurers to resolve claims and determine coordination of benefits. Accurately interpret remittance advices, payer bulletins or advisories, fee schedules and other pertinent information.
• Responsible for meeting productivity levels as defined in the critical elements specific to the position.
• Analyzes and determines appropriate action to account balance to provide thorough and timely follow-up. Accurately determines when contractual adjustments are needed or to balance bill the patient for services or items that are non-reimbursable per the payer.
• Responsible for ensuring payments are posted correctly. Submitting corrected claims to request adjustments by payers when appropriate.
• Research, analyze and resolves denied, rejected or edited claims for applicable payers.
• Responsible for accurate and prompt submission of all applicable primary and secondary claims to ensure timely payments and optimize reduction of A/R days. Includes obtaining all necessary information prior to billing, making corrections to errors, resolving any billing discrepancies, filing corrected claims when necessary, maintaining claim edits and rejections on billing system.

• Responsible for following accounts to final insurance payment including identifying appropriate accounts for write off. This requires daily contact with all payers to resolve claims that have not paid within a reasonable amount of time according to the policy and…