Revenue Cycle Specialist - Medicare

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Description

Revenue Cycle Specialist (Medicare)

Full Time
Location: Nashville, TN

Status: Regular Full Time

Days: Monday - Friday

Hours: 40/week

Are you a Revenue Cycle/professional who desires to work in a capacity in which your efforts directly impact clinicians, patients and their families? If you are excited to use your talents and skill set in a way that truly makes a difference in the middle Tennessee healthcare market, we can't wait to talk with you!

SUMMARY

Primarily responsible for generating billing cycles posting payments and follow-up on claims to ensure timely payment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Generates patient claims through EMR billing system. Upload EMC file to clearinghouse as soon after target bill date and errors/holds are clear. Continue review of unsubmitted claims to avoid timely filing errors.
Manage and hold claims waiting compliance review completion. Work with Revenue Cycle team to ensure billing compliance.
Review, key or follow up on 81A (NOE) prior to submission of initial claim. (if applicable to assigned duties)
Review, key or follow up on 815's, 817's and 818's when necessary.
Review and corrects RTP's in the DDE system on a regular basis.
Post Medicare PIP remittance advices through Clearinghouse auto post or manually when necessary.
Follows up regularly on unpaid claims by using DDE or phone call to PBGA service center for assistance or unresolved claim issues. Document response and any follow-up actions taken in EMR.
Work with the Dept. Director on Medicare credit balances to ensure compliance.
Work with other Hospice agencies to ensure smooth transitions between benefit periods and sequential billing.
Notifies the Dept. Director of any problems with claims or processes.
Assists other Revenue Cycle Specialist as needed to meet department goals.
Submit write off requests with documentation after all collection efforts have been exhausted to the Dept. Director.
Run admission report, assign and enter appropriate ICD-10 codes into EMR based on physician CTI. (if applicable to assigned duties)
Using pre-bill CPT audit sample to complete compliance review through physician coding compliance software. Report findings to appropriate Directors and CMO. (if applicable to assigned duties)
Report individual finds to the physician for review and resolution of the coding discrepancy. After physician review/approval make coding changes and note in EMR. Report to billing staff when claim can be released. (if applicable to assigned duties)
Other duties may also be assigned.

SUPERVISORY RESPONSIBILITES

No supervision of agency staff is required.

CERTIFICATES, LICENSES, REGISTRATIONS

If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law.

Requirements

CONTINUING EDUCATION

The agency requires this position to complete 6 hours of continuing education per year covering topics that will contribute to improvements in carrying out the above responsibilities. Regulatory agencies may require some disciplines to have additional hours in order to be licensed or certified.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including meeting the required competencies. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

High School diploma required. One year college or technical school: one to three years related experience or equivalent combination of education and experience.

Average salary estimate

$50000 / YEARLY (est.)

min

max

$40000K

$60000K

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What You Should Know About Revenue Cycle Specialist - Medicare, Alive

If you're an engaging and detail-oriented Revenue Cycle Specialist focused on Medicare, we have an exciting opportunity for you to shine at our Nashville, Tennessee location! This full-time role is all about making a significant difference in the healthcare landscape of Middle Tennessee. You'll be at the heart of the billing cycle, where your expertise will drive timely payments, aiding both clinicians and patients. Your daily work will include generating patient claims through our EMR system, managing compliance reviews, and ensuring we hit our target bill dates without a hitch. You'll also play a vital role in clearing up unpaid claims, collaborating closely with our Revenue Cycle team, and assisting with seamless transitions between benefit periods for our hospice agencies. Education and experience are essential, with a high school diploma or equivalent experience required, while prior experience in the billing field is a huge plus. With growth opportunities and a supportive team environment, being a Revenue Cycle Specialist at our company not only enhances your career but also places you in a position to truly impact lives. Let's connect and see how you can contribute to our fantastic team while making a difference in the healthcare sector!

Frequently Asked Questions (FAQs) for Revenue Cycle Specialist - Medicare Role at Alive

What are the primary responsibilities of a Revenue Cycle Specialist at our Nashville office?

As a Revenue Cycle Specialist at our Nashville location, your main responsibilities will include generating patient claims through the EMR billing system, managing compliance reviews, and ensuring timely claim submissions. You’ll also handle unpaid claims and collaborate with our Revenue Cycle team to maintain billing compliance.