Revenue Cycle Associate

Job Summary

To comply with and master all Government, Non-Government, and Third Party Payer regulations and contracts and to interpret these regulations to submit for processing and collect patient account balances. Interprets and applies compliance guidelines and in an effort to maintain billing integrity and reports any fraudulent or abusive practices to supervisor or other appropriate person (Compliance Officer, Supervisor, Manager, etc.). Comply and master an understanding of physician billing for each specialty type (Surgery, Oncology, Podiatry, Rheumatology, Family Medicine, etc).

Minimum Qualifications

• Minimum Education: High School Diploma or Equivalent
• Minimum Years of Experience: 1 Year of experience in healthcare business office or physician office environment
• Substitutable Education & Experience: None.
• Required Certifications/Licensure: None.
• Required Training: Procedural knowledge of Medical/Medicaid and third party liability billing, reimbursement, and regulatory compliance;  Procedural knowledge of account receivable management and understanding of entire revenue cycle.

Essential Functions

• Responsible for compliance with applicable payer policies, guidelines and regulations. Requires frequent contact with payers and insurers to resolve claims and determine coordination of benefits. Accurately interpret remittance advices, payer bulletins or advisories, fee schedules and other pertinent information.
• Responsible for meeting productivity levels as defined in the critical elements specific to the position.
• Analyzes and determines appropriate action to account balance to provide thorough and timely follow-up. Accurately determines when contractual adjustments are needed or to balance bill the patient for services or items that are non-reimbursable per the payer.
• Responsible for ensuring payments are posted correctly. Submitting corrected claims to request adjustments by payers when appropriate.
• Research, analyze and resolves denied, rejected or edited claims for applicable payers.
• Responsible for accurate and prompt submission of all applicable primary and secondary claims to ensure timely payments and optimize reduction of A/R days. Includes obtaining all necessary information prior to billing, making corrections to errors, resolving any billing discrepancies, filing corrected claims when necessary, maintaining claim edits and rejections on billing system.

Duties & Responsibilities

• Responsible for following accounts to final insurance payment including identifying appropriate accounts for write off. This requires daily contact with all payers to resolve claims that have not paid within a reasonable amount of time according to the policy and procedure.
• Identifies which charges, if any, are to be written off when specific criteria have not been met.
• Responsible for communicating with the physician practice manager or other departments to resolve any claim discrepancies.
• Responsible for identifying diagnoses’ or procedures which require supporting documentation and providing documentation to payer as needed. Knowledge of Medical Records billing instructions relating specifically to diagnosis codes and DRG’s.
• Responsible for maintaining billing integrity, alerting supervisor of any fraudulent or abusive billing practices, (e.g., duplicate billing, overstating charges, etc.).
• Abides by Service Expectations of Lexington Medical Center. Actively participates in departmental meetings and stays up to date of best practice.
• Perform all other duties as assigned by authorized personnel or as required in an emergency (i.e., fire or disaster).