Job Description

Job Description

Job Description

SUMMARY:

The Revenue Cycle Operations Coordinator is cognizant of the philosophy, standards, objectives and policies of the Department and the Organization. The Coordinator shall have a thorough understanding of the FQHC/Article 28, Article 31, and Dental Rules and Regulations around the Medicaid and Medicare

RESPONSIBILITIES:

• Compile and maintain records, statistics and reports as necessary.
• Identify and resolve trends impacting ability to collect. Anticipate needs and improve existing workflows or develop new workflows that facilitate collections efforts.
• Continuously reviews revenue cycle staff work for adherence to policies and procedures, to ensure the timely collections of insurance and patient due balances and that processing of denials are at optimal levels
• Ensure daily/weekly/monthly medical claim submission. Resolve claim and remittance file issues as needed.
• Ensure monthly patient statement billing and collections process
• Troubleshoot billing and resolve problems with appropriate agencies, departments, and/or management
• May assist with posting patient and insurance cash receipts, daily reconciliations, posting insurance denials, and work queue maintenance as needed to ensure all work is done timely to meet desired goals for designated area of accounts receivable.
• Maintain patient/employee confidentiality in the management of protected information
• Supervise and provide daily guidance to assigned staff to ensure appropriate and timely management of the receivables
• Prepare evaluations, counsel staff on performance, and execute disciplinary actions up to and including termination for all assigned staff
• Participate in the process of interviewing and hiring new staff
• Coordinate new hire initial training, shadowing, and evaluation
• Review and distribute correspondence and follow up as needed
• Monitor current status of work queues for assigned staff including primary, secondary, and tertiary status and follow up
• Identify and develop techniques to address issues creating unnecessary or excessive denials
• Reviews denial reports to identify trends and resolve claim issues
• Ensure all payments (ERA/Manual) are reconciled in a timely manner
• Coordinate matters of lockbox and cash application by ensuring cash is applied, posting is balanced, reports run, and capitation and other miscellaneous payments are posted and reconciled in Epic against bank cash receipts.
• Maintain assigned work queues
• Ensure staff maintains monthly membership logs and reports data on shared drive spreadsheets
• Communicate to Director of Revenue Cycle and IT department changes required to facilitate the collection process. This includes information relating to new product lines/plans as well as changes to existing product lines/plans and issues related to the EPIC system build.
• Ensures Retro Adjudication Work Queues are worked weekly to ensure that all affected dates of service are billed and/or rebilled to appropriate responsible party (i.e. Medicaid, Insurance Carrier or Self Pay). This review process would include but would not be limited to the following: correcting Insurance Coverage start/end dates, rebilling previously posted charges to correct carrier or patient, adjusting charges as needed for capitation or reversal of capitation, notifying patient, and working with health center
• Work with other management to create WQ & Follow up standards.
• Review and approve refund requests for assigned receivables and ensures process is followed. Coordinate processing with Finance Department.
• Respond to incoming telephone or mail inquiries from patients, IFH centers/department, providers and payers regarding outstanding balances
• Interact with other departments, insurance companies, medical professionals and patients’ on daily basis to resolve claims processing issues.
• Recognize issues relating to provider credentialing and facilitates resolution.
• May be responsible for Claim Printing/Reviewing of printed claim forms for accuracy to ensure claims are paid timely.
• May be responsible for the submission of electronic claim and/or patient statement files depending on designated accounts receivable are (eMedNY, Change Healthcare, Ability {or current vendors})
• Ensures smooth operations with clearinghouse vendor and facilitates payer requirements as needed for electronic claims processing and retrieval of electronic remittance advices.
• May develop workflows, standards, and work queue requirements for billing staff to ensure claims are captured, billed timely, and paid as contracted
• Generates standard A/R reports on a routine basis. Reports shall include an analysis of accounts receivable, denials, WQ issues related to system configuration, and needs assessment to improve cash flow.
• Participate in new staff orientation programs to familiarize them with coding and billing procedures and policy updates as deemed necessary
• May be asked to assist with special accounts receivable projects
• May be responsible for Monthly EOC Survey

SKILLS:

• Thorough understanding of FQHC, Article 28, Article 31, dental CMS, managed care, sliding fee, and commercial payer billing guidelines and regulations.
• Understanding of the implications of facility/group agreements with health plans and the supplemental payment process
• Ability to export, analyze, and format data which may include the development of graphs.
• Ability to resolve staffing issues with tact and with professionalism.
• Ability to maintain staff schedules and coordinate changes in responsibility as needed to ensure work is completed to meet deadlines.
• Performance management experience including coaching and developing staff, preparing evaluations, and executing disciplinary actions
• Understanding of medical Commercial, Medicaid, Medicare and Supplemental Payment Programs, Billing and Collections processes including electronic forms of data exchange (claims/ERA/Eligibility)
• Knowledge of cash application procedures and aged accounts receivable reporting
• Competent typing / keyboarding skills
• Ability to handle multiple priorities and to deal calmly with individuals under stress
• Basic computer skills, including Microsoft Word, Excel, Outlook and PowerPoint
• Knowledge of CPT and ICD-10 Diagnosis coding
• Proficiency in EPIC claims processing workflows preferred
• Ability to run and interpret/analyze Crystal Reports and EPIC Workbench reports preferred

QUALIFICATIONS:

• HS Diploma or GED required
• Associates Degree preferred
• Coding or Medical Billing Certification preferred
• At least two years supervisory experience required (preferably in healthcare)
• A minimum of 3 years of medical billing experience required
• Proficiency in EPIC claims processing workflows preferred
• Ability to run and interpret/analyze Crystal and EPIC Workbench reports preferred
• Prior experience as an IFH Revenue Cycle Specialist III preferred

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