Revenue Cycle Specialist II

This is a fully remote position, open to applicants in Ohio.

📋 Description

• The role involves the submission and resolution of medical claims that range from moderate to high complexity.

• It is essential to stay updated with governmental and third-party billing, follow-up, and appeal requirements to ensure compliant billing and follow-up for both inpatient and outpatient claims across all wholly owned facilities and physician entities, including adherence to internal and external policy standards.

• Timely and appropriate responses to requests from management, staff, or physicians are required.

• Patient and physician confidentiality and professionalism must be maintained at all times.

• The position requires following departmental policies and procedures to guarantee accurate and timely resolution of claims.

• Effective communication through telephone, form letters, e-mail, or internal correspondence is necessary to address patient inquiries and insurance issues.

• Attendance and participation in team meetings are expected.

• Worklists should be utilized to review and analyze account balances to facilitate payment collection for medical services provided.

• Multiple system applications will be used to review, update patient information, and research outstanding accounts receivable balances.

• Participation in the analysis of claims resolution and providing feedback to management for potential solutions and process enhancements is important.

• Follow-up with insurance companies is required to ensure appropriate payment on claims, resolve denials, correct claims, and file appeals.

• Act as a liaison between internal and external customers to assist in claims and receivables resolution in a high-volume environment.

• Document accounts with clear and concise language in accordance with departmental procedures.

• Review and respond to correspondence and inquiries received.

• Meet and exceed team productivity and quality standards.

• Take the lead on special projects as assigned.

• Participate in staff training sessions.

• Review complex claims issues for resolution and recommend process improvements.

• Execute other related duties as assigned.

⛳️ Requirements

• High School Equivalent / GED (Required)

• Associate's Degree (Preferred)

• Bachelor's Degree (Preferred)

• A minimum of 1 year of medical billing / claim experience (Required)

• Familiarity with medical billing software (Preferred)

• A solid understanding of claim submission (UB04/HCFA 1500) and third-party payers is required.

• Knowledge of procedural and ICD10 coding is essential.

• Basic understanding of medical billing terminology is required.

• Detail-oriented and organized with strong analytical and problem-solving skills are necessary.

• Excellent client service, communication, and relationship-building skills are crucial.

• Ability to work independently and collaboratively as part of a team in a fast-paced environment is required.

• Strong written and verbal communication skills are a must.

• Proven ability to use PCs, Microsoft Office suite (including Word, Excel, and Outlook), and general office equipment (i.e., printers, copy machines, FAX machines, etc.) is essential.

🏝️ Benefits

• Adherence to all policies and standards is required.

• Annual training, the UH Code of Conduct, and UH policies and procedures are implemented to ensure the appropriate use of PHI in the workplace.