Revenue Cycle Specialist Senior (REMOTE)

Overview:

The Revenue Cycle Specialist plays a crucial role in ensuring the efficient and accurate processing of medical claims within the central billing office. This role involves analyzing and resolving charge review and claim edit errors to prevent denials or rejections, verifying compliance with billing guidelines and regulations, and assigning appropriate medical codes. The Specialist is responsible for reviewing and analyzing denied claims, preparing and submitting corrected claims or appeals, and managing adjustments, write-offs, and refunds. Additionally, the role requires identifying and resolving undistributed insurance credits and outstanding balances, verifying patient insurance coverage, and acting as a subject matter expert on claim submission and reimbursement processes.

Essential Functions:

• Manage the entire revenue cycle for our FQHC, coding review, claim edits, payer rejections, cash posting including undistributed credits and identifying and appeal underpayments or partial payments, and process insurance refunds as required
• Monitor accounts receivable, including the tracking of unpaid claims and patient balances, and implement
• strategies to reduce days in A/R, considering FQHC reimbursement structures
• Perform daily cash posting activities, ensuring accurate and timely posting of all payments received from various sources including insurance companies, and government payers
• Ensure accurate coding and charge capture for all patient services, adhering to FQHC billing guidelines
• Verify patient insurance coverage and benefits to minimize claim rejection and denials
• Identify, implement, and train process improvements to enhance revenue cycle efficiency, including cash posting procedures, within our FQHC setting, specific to coding, denial management
• Assign appropriate CPT, ICD-10, and HCPCS codes based on clinical documentation
• Stay current with healthcare regulations, coding updates, and payer policies, particularly those affecting FQHCs in Texas
• Will be the project specialist for issues identified and will carry out completion of project

Knowledge, Skills and Abilities:

• Proven ability to cultivate proficient relationships and deliver exceptional customer service across multiple departments
• Familiarity with Texas Medicaid and Medicare billing requirements for FQHCs, including sliding fee scale implementation and wrap-around payments.
• Proficiency in electronic health record (EHR) and practice management software 
• Excellent analytical and problem-solving skills with attention to detail and accuracy in financial transactions
• Understanding of HIPAA regulations, and FQHC compliance requirements
• Ability to work independently and as part of a team in a fast-paced community health environment
• Conducts by example and upholds CommUnityCare’s mission and values, serving as a role model for ethical conduct

Minimum Education:

• Bachelor's Degree Business, Healthcare Administration or similar field of study required or 5 years of work experience in Revenue Cycle Management in lieu of degree

Prefered Minimum Experience:

• 3 years in healthcare revenue cycle management, with at least 2 years in FQHC or community health center setting. 
• 1 year Experience with ICD-10, CPT, and HCPCS coding systems, and HIPAA compliance.

Prefered Licenses/Certifications:

• Certified Professional Coder (CPC) Upon Hire Preferred or
  FQHC Billing Specialist Certification Upon Hire Preferred