Revenue Cycle Specialist, Ambulatory Infusion Center
The Revenue Cycle Specialist (RCS) supports all aspects of revenue cycle operations for the Ambulatory Infusion Center (AIC), including claim development, claim submission, denial and underpayment resolution, payment collection, cash posting, and revenue reconciliation. The RCS is an expert in medical benefit billing and knows how to navigate industry complexities to ensure appropriate payment for services and financial success of the AIC.
Essential Functions
- Accurately develop and submit professional medical claims to third party payers for administration of complex biologics and other therapies within the AIC.
- Process coordination of benefits for patients with multiple payers and/or other forms of financial assistance.
- Investigate claims denials and underpayments and determine appropriate strategy for resolution.
- Submit appeals as required and follow up timely to ensure appropriate payment.
- Complete adjustments according to policies and procedures.
- Collect, reconcile, and post third party and patient payments.
- Clearly, accurately, and concisely document notes in medical software system to facilitate care and payment.
- Answer phone calls, messages, and emails in a professional, timely manner, while maintaining patient privacy in compliance with HIPAA, PCI, and other regulations.
- Other duties as assigned.
Requirements
Education
- High school diploma or GED.
Experience
- At least two years of medical benefit billing experience required.
- Experience in an ambulatory infusion center preferred.
Knowledge, Skills, and Abilities
- Requires expert knowledge of medical benefit billing, third party insurance requirements, cash posting and reconciliation, and other pertinent aspects of revenue cycle operations.
- Collaborates with internal and external stakeholders to facilitate proper payment for services rendered.
- Capable of working both independently as well as part of an interdisciplinary team.
- Demonstrates critical thinking in identifying, assessing, and responding to billing and payment issues.
- Ability to multi-task and organize workload for efficient use of time.
- Strong communication skills, including active listening, speaking, and effective writing.
Working Conditions and Physical Requirements
- Normal office environment.
- Strength: position requires incumbent to seldom perform physical activities requiring ability to push/pull or lift objects of up to 20 pounds.
- Manual Dexterity: position requires incumbent to constantly perform simple motor skills such as standing or walking and manipulative skills such as writing; frequently perform simple and moderately difficult manipulative skills such as typing; and rarely perform difficult manipulative skills.
- Coordination: position requires incumbent to constantly perform gross body coordination such as walking and stooping and frequently perform tasks which require hand-eye coordination such as keyboard skills.
- Mobility: position requires incumbent to constantly perform mobility skills such as walking, standing, and sitting, with seldom-prolonged standing or sitting in an uncomfortable position.
- Visual Discrimination: position requires incumbent to frequently see objects closely for reading.
- Hearing: position requires incumbent to constantly be able to hear normal sound with some background noise.
Benefits
All Tulea Health employees enjoy competitive compensation with the opportunity for an annual bonus. Full-time and part-time employees receive paid time off, are eligible to participate in a 401(k) savings plan with company match, and have access to a comprehensive benefits package, including medical, dental, and vision insurance.
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