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Spartanburg Regional Healthcare System Revenue Management Specialist in Spartanburg, South Carolina

Position Summary

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.

Minimum Requirements

Education

  • High School Diploma or equivalency

Experience

  • 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

License/Registration/Certifications

  • N/A

Preferred Requirements

Preferred Education

  • N/A

Preferred Experience

  • In depth knowledge of all payer billing and eligibility requirements

Preferred License/Registration/Certifications

  • 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.

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