Revenue Cycle A/R Specialist (Hospital)(RCAR)

Candidate will work collaboratively with internal team members and contribute to a positive working environment and team spirit.  A dedicated remote office space must be available with high-speed internet and peripheral equipment.  

Required Qualifications:  

• Minimum of 5 years' experience in revenue cycle processes: 

• Within a hospital setting (UB04 format).  

• Proficient to Expert level insurance follow up, denials management, credit balance resolution. 

• Proficient to expert level knowledge of Cerner Community Works, CPSI, and/or MedHost. 

• Demonstrate experience with reviewing outstanding balances to resolution (Medicare, Medicaid, and Commercial payors). 

• Exceptional time management and organizational skills. 

• Ability to direct work with minimal supervision and ability to meet performance and quality goals. 

• High school diploma or GED required. 

• Execute and fulfill JTS’ Remote Staff Agreement to ensure Security and Privacy.    

Primary Responsibilities:    

• Works within payer portals, such as Availity, Optum, MMIS and Medicare Contractors  

• Understands payor contracts and can apply calculations to resolve under/overpayments. 

• Knowledge of medical terminology such as CPT, HCPCS, APC, ASC, DRG and ICD10.  

• Understands and ability to apply EOB. 

• Submits reconsiderations and appeals related to denials using payor documentation and portals.  

• Interacts with third party payors and patients to resolve account balances.  

• Ability to submit corrected claims billing. 

• Reviews, research, and resolves claim rejections to resolution. 

• Uses standard work processes in daily work activities to ensure performance goals.  

• Performs other duties as assigned. 

Preferred Education:    

• Associate or Industry Certification is a plus  

• HFMA Certified Patient Accounts Representative (CPAR, ACPAR or equivalent)  

• Certified Revenue Cycle Representative (CRCR)