Revenue Cycle Transaction Specialist (104039)

SECTION 1: Job Summary (Summary of the basic functions of the position)

Responsible data entry for medical billing from insurance companies (payors) and patients. Serves as a
liaison between practices, clinics, the business office, payors, and patients. Establishes and maintains
contacts with payor accounts’ representatives. Initiates telephone contact and answers all calls pertaining
to accounts. Maintains accurate information regarding patient accounts receivable. Maintains strict
confidentiality for all patient accounts. Follows approved processes, policies and procedures in executing
job duties.

SECTION 2: Duties and Responsibilities (Responsibilities necessary to accomplish job functions)

• Responsible for accurate and timely posting of patient and insurance transactions including charges, payments, adjustments and refunds into the practice management system.
• Processes patient and insurance refunds and issue refund checks to appropriate parties
• Keys data into computer to maintain billing records and prepare insurance form with data such as names of insurance company and policy holder, policy number, and physician diagnosis.
• Contacts insurance company to verify patient coverage and obtain information concerning extent of benefits.
• Generates appropriate paper work, including insurance claim forms (original and re-filed) and collection letters, mails monthly statements to patients.
• Reviews insurance claim forms for accuracy, retrieving and attaching appropriate dictation for claim, as needed.
• Reviews insurance payments (Explanation of Benefits – EOB’s), including Medicare and Medicaid payments for accuracy in account information and demographics.
• Determines adjustments of claims paid at the out-of-network rate to in-network rates, and processes
• write-offs on these adjustments.
• Answers patients' questions regarding statements and insurance coverage, answers telephone in a prompt, courteous, and helpful manner, screening calls, directing calls, providing information, answering questions, and taking accurate messages.
• Responds to all inquiries received from patients and payors either by telephone or written request
• Follows-up on unpaid insurance claims after denial, to obtain settlement of claim.
• Establishes and maintains contacts with payor accounts’ representatives.
• Reviews accounts receivable activities and calls on outstanding balances or claims.
• Handles transactions necessary on discharged patients.
• Completes and files all necessary paperwork for services rendered, i.e., charge tickets, patient forms, medical records, etc.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization

SECTION 3: Experience Requirements

• Three (3)+ years of work experience in medical billing and accounting experience.

SECTION 4: Knowledge, Skills and Abilities Requirements

• Thorough knowledge of medical billing procedures and medical insurance, including credit and collection procedures required.
• Thorough knowledge of Medicare rules and regulations.
• Thorough knowledge of medical accounts receivable collection procedures, including knowledge of insurance correspondence required.
• Detail oriented, professional attitude, reliable
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and team mate support needs
  • Able to communicate effectively in English, both verbally and in writing
• Mathematical and/or analytical ability for basic to intermediate problem solving
• Basic to intermediate computer operation
  • Proficiency with Microsoft Excel, Word, and Outlook
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

SECTION 5: Supervisory Responsibilities:

• This position has no supervisory responsibilities.