Revenue Cycle Specialist (Medicare)

SUMMARY

Primarily responsible for generating billing cycles posting payments and follow-up on claims to ensure timely payment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Generates patient claims through EMR billing system. Upload EMC file to clearinghouse as soon after target bill date and errors/holds are clear. Continue review of unsubmitted claims to avoid timely filing errors.
2. Manage and hold claims waiting compliance review completion. Work with Revenue Cycle team to ensure billing compliance.
3. Review, key or follow up on 81A (NOE) prior to submission of initial claim. (if applicable to assigned duties)
4. Review, key or follow up on 815's, 817's and 818's when necessary.
5. Review and corrects RTP's in the DDE system on a regular basis.
6. Post Medicare PIP remittance advices through Clearinghouse auto post or manually when necessary.
7. Follows up regularly on unpaid claims by using DDE or phone call to PBGA service center for assistance or unresolved claim issues. Document response and any follow-up actions taken in EMR.
8. Work with the Dept. Director on Medicare credit balances to ensure compliance.
9. Work with other Hospice agencies to ensure smooth transitions between benefit periods and sequential billing.
10. Notifies the Dept. Director of any problems with claims or processes.
11. Assists other Revenue Cycle Specialist as needed to meet department goals.
12. Submit write off requests with documentation after all collection efforts have been exhausted to the Dept. Director.
13. Run admission report, assign and enter appropriate ICD-10 codes into EMR based on physician CTI. (if applicable to assigned duties)
14. Using pre-bill CPT audit sample to complete compliance review through physician coding compliance software. Report findings to appropriate Directors and CMO. (if applicable to assigned duties)
15. Report individual finds to the physician for review and resolution of the coding discrepancy. After physician review/approval make coding changes and note in EMR. Report to billing staff when claim can be released. (if applicable to assigned duties)
16. Other duties may also be assigned.

SUPERVISORY RESPONSIBILITES

No supervision of agency staff is required.

LANGUAGE SKILLS

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

CERTIFICATES, LICENSES, REGISTRATIONS

If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law.

OTHER QUALIFICATIONS

One to three years of medical billing experience, using computer based applications. Good organizational skills.

Communication and Relationship Skills: Exemplifies high level of written oral and listening communication skills, always respecting patient confidentiality.

Agency Policy and Philosophy: Communicates and supports agency mission and values in all professional interactions.

Continuing Education: Seeks to improve knowledge and skills relative to performance of job and personal growth.

Quality and Performance Improvement: Participates in new and continuing programs designed to monitor and improve quality and performance relevant to the mission and philosophy of Alive Hospice, Inc.

Teamwork: Functions consistently and collaboratively as an integral part of Administrative Services Department Team and other teams (committees, etc.) bringing experience and education to contribute to optimal team functions and outcomes.

Ethics: Demonstrates a high level of work, personal and professional ethics.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel. The employee frequently is required to sit and talk and hear. The employee is occasionally required to stand; walk; reach with hands and arms; and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision and the ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally exposed to moving mechanical parts and infectious diseases. The noise level in the work environment is usually moderate. Usually in a general office setting.

CONTINUING EDUCATION

The agency requires this position to complete 6 hours of continuing education per year covering topics that will contribute to improvements in carrying out the above responsibilities. Regulatory agencies may require some disciplines to have additional hours in order to be licensed or certified.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including meeting the required competencies. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

High School diploma required. One year college or technical school: one to three years related experience or equivalent combination of education and experience.