Revenue Cycle Specialist - Critical Care

Who is EMS|MC

EMS|MC offers full-service revenue cycle management solutions and is the largest billing services provider focused exclusively on emergency medical services in the U.S. We offer services from software to hardware to billing services and everything in between.

For over 25 years, our high-quality service, results and customer-centric approach have set the standard in professional EMS billing. We have an emphasis on patient satisfaction and our client customization enables us to fulfill our mission of providing value-added, innovative financial services that enhance the delivery of a cost-effective EMS system.

With this level of specialization, we have built a team of dedicated, industry-leading experts with unprecedented experience to maximize our clients EMS revenue.

Why EMS|MC:

• Career development plans and employee resource groups
• Weekly wellness seminars
• Comprehensive benefit package including medical, dental, vision and life insurance
• Remote opportunities
• All equipment provided

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Job Type: Full-time

Location: Remote- USA

Title: Revenue Cycle Specialist - Critical Care

About the role: Review and process claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for critical care clients.

 As a Revenue Cycle Specialist - Critical Care with EMS|MC, you will: 

• Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance
• Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff
• Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues 
• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim
• Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion
• Regularly meet, and effectively communicate with, Sr. Revenue Cycle Manager, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs 
• Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though 
• Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved
• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness 
• Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs
• Conduct all job tasks, calls, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations
• Consistently support and demonstrate the company mission and values
• Provide WOW service to patients, answering their concerns, providing them all necessary information and maintaining HIPAA protocol
• Obtaining front end eligibility and benefit information and providing this information accurately and efficiently to the client. Completing pre-certifications when applicable
• Conduct payment audits on accounts to ensure maximum reimbursement was achieved 
• Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Revenue Cycle Manager, Operations Manager or Director
• Serve as backup to other teams members as required, which may include billing
• Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist, Revenue Cycle Manager, Operations Manager, or Director

 You will be successful in this role if you: 

• Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service Level Agreements, A/R Aging, Net Collection Percentages, Average Cash Per Trip, Denials, Rejections, Account Review Aging, and maintaining a 96% audit score monthly. 
• High School Diploma
• At least 1-2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience
• Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though 
• Ability to organize, prioritize and multi-task  
• Ability to learn, understand, and work within specific compliance, client, and payer requirements
• Approach all tasks, duties, and interactions with an attitude of continuous improvement
• Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties
• Ability to function well within a cross-functional team setting and independently
• Detail-oriented
• Resourceful
• Self-starter
• Must possess critical thinking/analytical skills
• Proficient in Microsoft Office programs

 Key skills we hope you have: 

• Strong preference for prior EMS billing and/or denials experience
• Proficient in EMS|MC billing software
• General office environment
• Frequent typing
• Sitting, standing, walking
• Use of basic office equipment such as computer, fax, printer, copier, and telephone