Revenue Cycle Medical Specialist

DescriptionNature & scopeA Revenue Cycle Medical Specialist plays a critical role within the company, ensuring financial health by managing the entire billing and revenue cycle. This position involves coordinating with various departments to streamline billing processes, optimize reimbursements, and minimize denials. The specialist works closely with insurance companies, patients, and internal stakeholders to ensure accurate and timely processing of claims and payments. The role demands a thorough understanding of healthcare billing codes, payer requirements, and regulatory guidelines to maximize revenue while maintaining compliance.Minimum eligibility requirementsMust have patient care billing experienceEssential Duties and Responsibilities The Revenue Cycle Medical Specialist handles billing and collections with various insurance providers (i.e BCBS, United Health, Medicaid, Tricare, Humana, Managed Care Plans etc.). Responsible for compiling data, computing fees, and maintaining billing records Under direct supervision, performs complex data entry and related operations in posting payments from patients and third parties Reviewing patient charts ensuring all billing parameters having been completed and covered for maximum payment Posts payments and credits in EHR system, while maintaining compliance and resolving account problems Assign appropriate medical codes using various coding systems Follow up on unpaid or denied claims and resolve billing discrepancies Verify patient information, insurance coverage, and billing details Prepare and submit claims to insurance companies for reimbursement Maintain confidentiality of patient information and adhere to HIPAA regulations Collaborate with healthcare providers and staff to ensure accurate and timely billing Review and analyze medical records and documentation to ensure accurate coding and billing Assign appropriate codes to medical procedures and diagnoses Verify patient insurance coverage and process claims for reimbursement Investigate and resolve claim denials or rejections in a timely manner Collaborate with insurance companies to address any billing discrepancies Monitor and track the status of submitted claims Provide excellent customer service to patients regarding billing inquiries (EOBs) Collaborate with healthcare providers to resolve coding and billing discrepancies Stay up-to-date with changes in medical coding guidelines and regulations Utilize various systems and software to input and retrieve coding information accurately Compiles/Submits required documentation for insurance audits/reviews Maintain confidentiality of patient information and adhere to HIPAA guidelines Communicates with patients or third-party representatives by telephone, fax, e-mail, or postal mail to verify accuracy of charges, investigate complaints, or to correct errors in accounts Answers mail and telephone inquiries regarding rates, services, and procedures Receives payments from third party payers, or from patients via check or credit card; posts and reconciles payments to ledgers Reviews refunds and adjustments; reconciles, corrects, and applies adjustments to billing records