Spartanburg Regional Healthcare System Revenue Management Specialist in Spartanburg, South Carolina
The AR management specialist works with unique department billing/collection functions to assure accounts are managed accurately and timely. Responsibilities will vary based on department need.
- High School Diploma or equivalency
4 years medical office or medical billing in a hospital or physicians billing setting, collections or coding experience.
Must possess strong knowledge of CPT, HCPCS and ICD-9/10 codes.
Must be efficient in reading insurance explanation of benefits (EOB) and understanding of remittance and remark codes.
Good working knowledge of Microsoft Excel
Good communication skills and the ability to interact well with multiple departments/levels of management
- In depth knowledge of all payer billing and eligibility requirements
Certified Procedural Coder (CPC) (CPC-H)
Certified Revenue Cycle Associate (CRCA)
Certified Medical Insurance Specialist (CMIS)
Registered Health Information Technician (RHIT)
Core Job Responsibilities
Responsible for research and resolution of all outstanding patient and insurance credit accounts, any additional A/R management research and account updates required to ensure claims are filed to the appropriate carrier or posted correctly.
Processing of all refunds or credit reversals in a timely manner as defined within the departmental credit/refund policy/procedures.
Responsible for all government monthly credit reporting preparation and requirements
Responsible for accurate charge capture, charge review, claim edits, posting to the AR system and resolution of all charge edits.
Responsible to handle all denials related to charge capture for improved integrity of charge capture
Responsible to accurately update patient demographics, insurance registration information, verification of insurance, etc.
Responsible for the consolidation of duplicate guarantor/patient accounts within the AR management system in an accurate/timely manner.
Responsible for the review and processing of Accounts Receivables reports to ensure revenue integrity. Reporting trends identified during the analysis.
Responsible to research and complete a detailed analysis of all payer variances based on our Contract modeling within our AR system.
Revenue Management Specialist must have the skill set and understanding of payer and government payer contracts/schedules in order to confirm expected reimbursement amounts are correct.
Work closely with other departments on revenue integrity issues including variance contract build issues, charging issues, A/R type issues and other items as define.
Responsible for all account financial changes and refiling of those claims to the appropriate payer source.
Assist with payer/physician credentialing and system table management.
Responsible for electronic remittance, eligibility and claims agreements to insure the proper processing of electronic transactions, electronic remittance requirements and other payer requirements for billing.
Responsible for the processing of all vendor claim updates, returns and resubmissions for payment.
Other duties as assigned.