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Revenue Cycle Specialist / Billing Specialist

Company: HAPPY KIDS PEDIATRICS, P.C.
Location: mesa
Posted on: May 3, 2021

Job Description:

Description

Happy Kids Pediatrics is seeking a strongRevenue Cycle Specialist / Billing Specialistto make a difference in our Primary Care office at Happy Kids Pediatrics!

Who we are

Happy Kids Pediatrics is a family run business whose mission is to serve, educate, and be involved in the community. The family atmosphere we have established in our practice helps us get to know our patients on a deeper level. We are always willing to lend a helping hand in any way we can.

At Happy Kids Pediatrics, our primary goal is to provide quality care to children and ensure their good health from infancy through adolescence. Our practice incorporates a team mentality between the providers, the parents and the patients in order to reach our goal of providing the highest quality of care. Teamwork helps us to every child receives comprehensive preventative health care and that parents understand the development processes that are a part of growing up for the child.

Who We Need

Job Summary

Under the supervision of the Revenue Cycle Director the Revenue Cycle Specialistis responsible for a variety of lifecycle claim management functions including timely claim submission, collection, and reimbursements. The core responsibility of the Revenue Cycle Specialist is the engagement of accurate and timely claim submissions, working collaboratively with office staff on eligibility issues and obtaining authorizations and pre-certs as required by the individual insurance company. Additionally, The Revenue Cycle Specialist is also responsible for reconciling rejected claims from EMR and Clearinghouse vendors, including obtaining missing information, aging claims/follow-up, and limited charge entry.

MINIMUM QUALIFICATIONS

  • Requires a High School Diploma or GED (General Equivalency Diploma).
  • College course work a plus.
  • A minimum of one (1) year of experience, in a medical office setting, with claim submission, posting remittance advices, paper and electronic, in billing software.
  • Successfully complete a pre-employment drug screening.
  • Must be able to lift minimum 50 pounds, stoop and bend comfortably in all positions.
  • Microsoft Office experience which includes Word, Access, Outlook, and a strong knowledge of Excel.
  • Possess strong analytical, organizational, and problem-solving skills; ensures efficiency and quality standards are met.
  • Satisfactory work records as determined by the Human Resources Department.
  • Bi-Lingual, preferred.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

  • Responsible for the maintenance and data entry of patient insured and demographic information as related to clean claim submission.
  • Perform benefit verification & prior authorization for Medicaid, Medicare, and Commercial insurances, as needed.
  • Responsible for full cycle billing efforts including claim submission and timely adjudication.
  • Perform, identify, collect, and confirm insurance coverage to include obtaining prior authorization, third party liability and coordinator of benefits.
  • Maintains professional growth and certifications by attending and participating in corporate, departmental, and individual training & development programs to develop and enhance skills.
  • Understand billing requirements for all payers and participate in ensuring claims are accurate prior to submission; train staff on billing requirements for new and established payers.
  • Maintains productivity and quality standards as determined by the practice.
  • To ensure compliance & adequate services, additional job duties may be required to meet the needs of the Revenue Cycle Department.
  • Corrects client identification errors as reported.
  • Updates patient demographic and guarantor information based on rejects from the exception report.
  • Review information to ensure that it meets the medical and billing criteria or adjudication.
  • Initiate and follow up on pre-determinations with applicable insurance in a timely manner.
  • Ensures Physician documentation supports payer requirements for authorization processing.
  • Responsible for the collection and submittal of appropriate documentation to prove the medical necessity of authorized service per health plan guidelines.
  • Logging, tracking and notification of submissions, imports, and postings of response files.
  • Works in conjunction with office staff to ensure data entry functions are completed prior to upload process.
  • Responsible for reviewing and researching items on the system generated exception reports and ensuring completeness and readiness for clean claim submission.
  • Work with insurance provider reps to maintain correct and timely processing of claims or any billing issues.
  • Maintains professional growth and certifications by attending and participating in corporate, departmental, and individual training & development programs to develop and enhance skills.
  • Understand billing requirements for all payers and participate in ensuring claims are accurate prior to submission; train staff on billing requirements for new and established payers.
  • All other duties, as assigned.

Keywords: HAPPY KIDS PEDIATRICS, P.C., Mesa , Revenue Cycle Specialist / Billing Specialist, Other , mesa, Arizona

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