CCS Medical

Sr. Revenue Cycle Specialist

US-FL-Clearwater
ID
2017-2130
Category
Administrative/Clerical
Position Status
Regular Full-Time
Position Schedule
Monday-Friday
Shift
9-5:30

Overview

Position Summary: Responsible for claim submission and claim resolution for CCS Medical patients in regards to governmental, commercial insurance companies and patient accounts. Provides guidance to department staff and complete special projects while keeping management informed of escalated matters.

Responsibilities

  

ESSENTIAL DUTIES

  • Works individual portfolio of accounts from CCS Medical billing/collection system
  • Assesses insurance reimbursement for individual supplies to ensure maximum reimbursement
  • Verifies that all appropriate supporting documentation are obtained prior to shipment and/or prior to billing
  • Audits configuration of supplies based on supporting documentation, formulary requirements and manufacturer compatibility
  • Researches and follows up on all correspondence associated with assigned accounts, including EOB’s and documentation letters, and generate correspondence requesting required information, when necessary
  • Initiates appeals and ensure all required documentation is submitted in the appeals process. Research all denials and follow up as necessary.
  • Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds
  • Reduces delinquent accounts and achieves maximum collections from all sources
  • Produces reports identifying trends or problem carriers, and identify areas of concern and present ideas to correct or prevent future issues
  • Analyzes and corrects accounts receivable problems
  • Posting payments and/or adjustments to individual accounts
  • Resolving credit balance accounts as needed
  • Documents all activities as completely as possible
  • Achieves productivity goals based on accounts touched, dollars collected, and aging period
  • Provides guidance to team regarding questions related to daily work and escalates issues to Department Manager
  • Assists Department Manager with employee coaching, training and development initiatives
  • Montors progress of newly trained staff and reports progress to Department Manager
  • Leads by example to promote professionalism in all areas
  • Maintains a high degree of confidentiality at all times due to access to sensitive information
  • Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
  • Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements
  • Abides by all regulations, policies, procedures and standards

Qualifications

 

Performance Responsibilities:

  • Exercises appropriate cost control measures
  • Maintains positive internal and external customer service relationships
  • Maintains open lines of communication
  • Plans and organizes work effectively and ensures its completion
  • Meets all productivity requirements
  • Demonstrates team behavior and promotes a team-oriented environment
  • Actively participates in Continuous Quality Improvement
  • Represents the organization professionally at all times

 

Position Requirements & Competencies:

  • High school diploma or GED equivalent.
  • Minimum of two years of medical billing/collections experience necessary.      
  • Must be knowledgeable of reimbursement processes and procedures.
  • Ability to work with other employees and provide assistance as needed
  • Proficient in Microsoft Outlook, Word, Excel, PowerPoint and computer literacy
  • Organized work habits, accuracy, and proven attention to detail, with strong analytical skills
  • Ability to work within a team setting and as an individual contributor
  • Excellent oral and written communication skills
  • Self-directed with the ability to work with little or no supervision
  • Flexible and cooperative in fulfilling all obligations
  • Ability to interpret rules and regulations set by Medicare, Medicaid, and Commercial payors

 

Equal Opportunity Employer/Veterans/Disabled

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