Revenue Cycle Specialist

Description

Southeastern Cardiology Associates, Southeastern Gastroenterology Associates, and SBD Medical Solutions strive to deliver the best care possible through a team approach. From check-in to check-out, each employee participates in delivering the highest quality of care and attention in the Southeast. Our commitment to our patient is that we will treat them like family. 

We are compassionate and considerate. We are passionate about advancements in technology and patient care. We are educators and good listeners. We believe that qualified specialty care is not hard to find. However, we think that embedding a world-class group of specialists within a team that is committed to treating the patient and their loved ones is what truly sets us apart. Our job is not done when the condition is diagnosed and treated appropriately. We consider the mission accomplished when we have treated the problem and our team has communicated effectively with the patient and their loved ones. Above all, we are here to serve our patients and their families. Our team of specialized physicians, mid-levels, nurses, technicians, and staff are committed to providing the highest level of service – this team approach truly sets us apart. 

Responsibilities  

• Monitors unpaid claims to determine necessary actions to assure timely resolution  
• Works payer correspondence and resolves requests 
• Monitors denied claims, in collaboration with coding team, to facilitate timely resolution 
• Monitors EOBs for accuracy 
• Obtains and submits necessary documentation required for submitted claims resolution 
• Reviews patient bills for accuracy and completeness of insurance payment and contractual adjustments 
• Performs tasks associated with secondary insurance claim submission, including copying, preparing, and attaching EOB from primary payer as necessary 
• Anticipates potential billing/reimbursement problems and takes measures to prevent them 
• Answers billing related questions from patients and insurance companies 
• Assists the RCM director in a variety of other daily tasks, as necessary  

Requirements

Education and Qualifications: 

• High school graduate or GED equivalent 
• Insurance billing and/or coding experience required  
• Certified professional biller preferred or ability to obtain through the AAPC within 2 years  
• Maintains knowledge of current regulations and policies for the federal, state and private payers 
• Maintains knowledge of CPT and HCPCS codes 

Job Skills: 

• Demonstrates the ability to achieve accuracy and consistency  
• Applies knowledge to produce “clean claims” 
• Monitors unbilled accounts and/or uncoded encounters to reduce any billing delays  
• Applies knowledge of regulatory mandates and reporting requirements  

Corporate Culture Expectations
Demonstrates the office Corporate Culture at all times with colleagues, providers, outside offices/vendors, patients, and patient’s family members. Consistently portrays a positive attitude; excels in individual role while creating a culture of teamwork and cooperation; puts the patient/family first and regularly seek opportunities for self-improvement as well as operational improvement.  

Core Competencies  
Approachability, Compassion, Customer Focus, Dealing with Ambiguity, Decision Quality, Ethics & Values, Integrity & Trust, Motivating Others, Peer Relationships, Drive for Results, Listening  

Functional Competencies  
Composure, Listening, Organizing, Patience, Problem Solving, Technical Learning, Time Management, Understanding Others