STAMFORD HEALTH IS COMMITTED TO PREVENTING THE SPREAD OF INFECTIOUS DISEASES AND CARES ABOUT YOUR HEALTH AND THE HEALTH OF OUR EMPLOYEES. TO THAT END, IF YOU ARE INVITED TO INTERVIEW IN ONE OF OUR OFFICES/CAMPUSES, AND YOU OR A MEMBER OF YOUR FAMILY AND/OR SIGNIFICANT OTHER IS EXPERIENCING SYMPTOMS (I.E. FEVER, COUGHING OR OTHER RESPIRATORY SYMPTOMS), OR YOU SIMPLY DON’T FEEL WELL, PLEASE INFORM THE HR REPRESENTATIVE IMMEDIATELY SO WE MAY SCHEDULE YOUR INTERVIEW FOR A LATER DATE. WHEN ARRIVING ON OUR CAMPUS OR SITE WHETHER FOR AN INTERVIEW OR TO BEGIN YOUR EMPLOYMENT WITH US, PLEASE NOTE IT IS IMPERATIVE YOU ABIDE BY CT STATE GUIDELINES ON TRAVEL ADVISORY WHICH CAN BE FOUND HERE https://portal.ct.gov/Coronavirus/Travel.  PLEASE SCHEDULE ACCORDINGLY AND UPDATE YOUR HR REPRESENTATIVE IMMEDIATELY TO MAKE ANY NECESSARY ARRANGEMENTS/ADJUSTMENTS TO SCHEDULING.

The Revenue Cycle Specialist is responsible for supporting the Accounts Receivable team with a focus Denial Resolution: researching, resolving, and resubmitting denied claims; taking timely and routine action to collect unpaid claims; and interpreting various forms of explanations of benefits (EOBs) from insurance carriers.

MAJOR RESPONSIBILITIES:

DENIAL RESOLUTION FOCUS: 

• Understands and interprets insurance Explanations of Benefits (EOBs), knowing when and how to ensure that maximum payment has been received.
• Researches and resolves rejected, incorrectly paid, and denied claims within an established time frame.
• Researches and resolves unpaid accounts receivable and makes any corrections in medical group’s practice management system necessary to ensure maximum reimbursement for all services rendered.
• Resubmits claim forms as appropriate.
• Professionally responds to all billing-related inquiries from patients, staff, and payers in a timely manner.
• Utilizes available resources to identify reasons for payment discrepancies.
• Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
• Accurately documents patient accounts of all actions taken.
• Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements.
• Educates clinic management and staff regarding changes to insurance and regulatory requirements.
• Actively participates in practice management and payer meeting.

RELEVANT TO THIS FOCUS:

• Accurately documents patient accounts of all actions taken.
• Establishes and maintains a professional relationship with all SHMG staff in order to resolve problems and increase knowledge of account management.
• Maintains standards set by management.
• Apprises management of concerns as appropriate.
• Informs management, as appropriate, regarding backlogs and time available for additional tasks.
• As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.
• Completes additional projects and duties as assigned.

Required Skills

QUALIFICATIONS/REQUIREMENTS:

Associate’s degree or medical billing certification preferred. CPC preferred.

3+ years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.

3+ years of experience working with a medical office/hospital accounts receivable system.

Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.

Demonstrates overall knowledge of claims processing for various insurances, including private and governed.

Comprehensive knowledge of ICD-10, CPT, and HCPCS coding.

Bi-lingual Spanish preferred

Required Experience

QUALIFICATIONS/REQUIREMENTS:

Associate’s degree or medical billing certification preferred. CPC preferred.

3+ years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.

3+ years of experience working with a medical office/hospital accounts receivable system.

Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.

Demonstrates overall knowledge of claims processing for various insurances, including private and governed.

Comprehensive knowledge of ICD-10, CPT, and HCPCS coding.

Bi-lingual Spanish preferred