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Revenue Management Specialist

Company: Spartanburg Regional Healthcare System
Location: Spartanburg
Posted on: March 15, 2020

Job Description:

Position SummaryThe AR management specialist works with unique department billing/collection functions to assure accounts are managed accurately and timely. Responsibilities will vary based on department need. Minimum Requirements Education

  • High School Diploma or equivalency Experience
    • 4 years medical office or medical billing in a hospital or physicians billing setting, collections or coding experience.
    • Must possess strong knowledge of CPT, HCPCS and ICD-9/10 codes.
    • Must be efficient in reading insurance explanation of benefits (EOB) and understanding of remittance and remark codes.
    • Good working knowledge of Microsoft Excel
    • Good communication skills and the ability to interact well with multiple departments/levels of management License/Registration/Certifications
      • N/APreferred RequirementsPreferred Education
        • N/APreferred Experience
          • In depth knowledge of all payer billing and eligibility requirementsPreferred License/Registration/Certifications
            • Certified Procedural Coder (CPC) (CPC-H)
            • Certified Revenue Cycle Associate (CRCA)
            • Certified Medical Insurance Specialist (CMIS)
            • Registered Health Information Technician (RHIT)Core Job Responsibilities
              • Responsible for research and resolution of all outstanding patient and insurance credit accounts, any additional A/R management research and account updates required to ensure claims are filed to the appropriate carrier or posted correctly.
              • Processing of all refunds or credit reversals in a timely manner as defined within the departmental credit/refund policy/procedures.
              • Responsible for all government monthly credit reporting preparation and requirements
              • Responsible for accurate charge capture, charge review, claim edits, posting to the AR system and resolution of all charge edits.
              • Responsible to handle all denials related to charge capture for improved integrity of charge capture
              • Responsible to accurately update patient demographics, insurance registration information, verification of insurance, etc.
              • Responsible for the consolidation of duplicate guarantor/patient accounts within the AR management system in an accurate/timely manner.
              • Responsible for the review and processing of Accounts Receivables reports to ensure revenue integrity. Reporting trends identified during the analysis.
              • Responsible to research and complete a detailed analysis of all payer variances based on our Contract modeling within our AR system.
              • Revenue Management Specialist must have the skill set and understanding of payer and government payer contracts/schedules in order to confirm expected reimbursement amounts are correct.
              • Work closely with other departments on revenue integrity issues including variance contract build issues, charging issues, A/R type issues and other items as define.
              • Responsible for all account financial changes and refiling of those claims to the appropriate payer source.
              • Assist with payer/physician credentialing and system table management.
              • Responsible for electronic remittance, eligibility and claims agreements to insure the proper processing of electronic transactions, electronic remittance requirements and other payer requirements for billing.
              • Responsible for the processing of all vendor claim updates, returns and resubmissions for payment.
              • Other duties as assigned.

Keywords: Spartanburg Regional Healthcare System, Spartanburg , Revenue Management Specialist, Executive , Spartanburg, South Carolina

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