North Mississippi Health Services
Overview
JOB SUMMARY The Revenue Cycle Specialist at North Mississippi Health Services is responsible for facilitating effective Revenue Cycle flow, which includes bill processing and resolution, denials and appeals management, and recurring reporting generation to monitor status and performance. This role operates under the guidance of the Billing Manager and requires an experienced individual with knowledge of third party payers and contracts and excellent organizational, analytical, and communication skills to effectively interface with third party payers, vendors, and staff in claims review, analyze reports and claims to identify underpayments and trends, and facilitate action to support claim resolution and payment capture to promote overall effective and efficient area function and the financial health of the organization.
Responsibilities
Billing & Follow Up: Processes Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format.
Billing & Follow Up: Conducts billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim.
Billing & Follow Up: Facilitates information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment.
Denial Management: Manages denial receivable to resolve accounts.
Denial Management: Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
Denial Management: Analyzes denials to determines reason they occurred.
Denial Management: Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager.
Denial Management: Takes corrective action through systematic and procedural development to reduce or eliminate payment issues.
Contract Management: Maintains familiarity with payer methodologies and the ability to communicate with NMHS staff.
Contract Management: Manages paid claims to resolve underpaid accounts.
Contract Management: Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
Contract Management: Analyzes underpayments to determine reason they occurred.
Contract Management: Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager.
Communication: Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance.
Liaison: Contacts insurance companies regarding denial, underpayments or rejection issues.
Liaison: Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues.
Reporting: Assists in preparation of monthly denial reports and other denial reports as requested.
Reporting: Assists in preparation of monthly variance reports and other variance reports as requested.
Regulation: Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
Regulation: Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.
Qualifications
Education
Bachelor's Degree in Business, coding or equivalent field. Required
Associate's Degree Willing to consider 4 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required
High School Diploma or GED Equivalent Willing to consider 8 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required
Licenses and Certifications
Work Experience
1-3 years
Knowledge Skills and Abilities
Excellent analytical and problem-solving skills
Good organizational and communication (written and verbal) skills
Excellent interpersonal skills
Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites
Must be able to research, analyze and communicate payer trends to identify reimbursement and training issues
Must professionally and effectively communicate with third party carriers, vendors, and hospital contacts to promote contractual compliance
Must provide input and help design payer report cards in conjunction with contracting, managed care, and other revenue cycle departments
Must serve as member of the Denials Committee
Must conduct training sessions with Billing and Follow-up staff as needed
Must have effective negotiating skills, including the ability to resolve difficult claims issues
Must be able to gather and share information with knowledge, tact, and diplomacy
Must have extensive contact with: patients, payers, physician office staff, coding staff, Credentialing, Case Management, various Department heads, and all staff within the department
Physical Demands A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Standing. Constantly
Walking. Frequently
Sitting. Rarely
Lifting/Carrying. Frequently 50 lbs
Pushing/Pulling. Frequently
Climbing. Occassionally
Balancing. Occassionally
Stooping/Kneeling/Bending. Frequently
Reaching/Over Head Work. Frequently
Grasping. Frequently
Speaking. Occassionally
Hearing. Constantly
Repetitive Motions. Constantly
Eye/Hand/Foot Coordinations. Frequently
Benefits
A****vailable
Continuing Education
403B Retirement Plan with Employer Match Contributions
Pet, Identity Theft and Legal Services Insurance
Wellness Programs and Incentives
Referral Bonuses
Employee Assistance Program
Medical Benefits
Dental Benefits
Vision Benefits
License+ Certification Reimbursement
Life, Long-Term and Short-Term Disability, Group Accident, Critical Illness and Hospital Indemnity Insurance
Employee Discount Program
Other:
Early Access to Earned Wages
Tuition Assistance
Relocation Assistance
Paid Time Away
Special Employee Rates at NMMC Wellness Centers
#J-18808-Ljbffr
JOB SUMMARY The Revenue Cycle Specialist at North Mississippi Health Services is responsible for facilitating effective Revenue Cycle flow, which includes bill processing and resolution, denials and appeals management, and recurring reporting generation to monitor status and performance. This role operates under the guidance of the Billing Manager and requires an experienced individual with knowledge of third party payers and contracts and excellent organizational, analytical, and communication skills to effectively interface with third party payers, vendors, and staff in claims review, analyze reports and claims to identify underpayments and trends, and facilitate action to support claim resolution and payment capture to promote overall effective and efficient area function and the financial health of the organization.
Responsibilities
Billing & Follow Up: Processes Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format.
Billing & Follow Up: Conducts billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim.
Billing & Follow Up: Facilitates information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment.
Denial Management: Manages denial receivable to resolve accounts.
Denial Management: Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
Denial Management: Analyzes denials to determines reason they occurred.
Denial Management: Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager.
Denial Management: Takes corrective action through systematic and procedural development to reduce or eliminate payment issues.
Contract Management: Maintains familiarity with payer methodologies and the ability to communicate with NMHS staff.
Contract Management: Manages paid claims to resolve underpaid accounts.
Contract Management: Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
Contract Management: Analyzes underpayments to determine reason they occurred.
Contract Management: Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager.
Communication: Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance.
Liaison: Contacts insurance companies regarding denial, underpayments or rejection issues.
Liaison: Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues.
Reporting: Assists in preparation of monthly denial reports and other denial reports as requested.
Reporting: Assists in preparation of monthly variance reports and other variance reports as requested.
Regulation: Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
Regulation: Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.
Qualifications
Education
Bachelor's Degree in Business, coding or equivalent field. Required
Associate's Degree Willing to consider 4 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required
High School Diploma or GED Equivalent Willing to consider 8 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required
Licenses and Certifications
Work Experience
1-3 years
Knowledge Skills and Abilities
Excellent analytical and problem-solving skills
Good organizational and communication (written and verbal) skills
Excellent interpersonal skills
Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites
Must be able to research, analyze and communicate payer trends to identify reimbursement and training issues
Must professionally and effectively communicate with third party carriers, vendors, and hospital contacts to promote contractual compliance
Must provide input and help design payer report cards in conjunction with contracting, managed care, and other revenue cycle departments
Must serve as member of the Denials Committee
Must conduct training sessions with Billing and Follow-up staff as needed
Must have effective negotiating skills, including the ability to resolve difficult claims issues
Must be able to gather and share information with knowledge, tact, and diplomacy
Must have extensive contact with: patients, payers, physician office staff, coding staff, Credentialing, Case Management, various Department heads, and all staff within the department
Physical Demands A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Standing. Constantly
Walking. Frequently
Sitting. Rarely
Lifting/Carrying. Frequently 50 lbs
Pushing/Pulling. Frequently
Climbing. Occassionally
Balancing. Occassionally
Stooping/Kneeling/Bending. Frequently
Reaching/Over Head Work. Frequently
Grasping. Frequently
Speaking. Occassionally
Hearing. Constantly
Repetitive Motions. Constantly
Eye/Hand/Foot Coordinations. Frequently
Benefits
A****vailable
Continuing Education
403B Retirement Plan with Employer Match Contributions
Pet, Identity Theft and Legal Services Insurance
Wellness Programs and Incentives
Referral Bonuses
Employee Assistance Program
Medical Benefits
Dental Benefits
Vision Benefits
License+ Certification Reimbursement
Life, Long-Term and Short-Term Disability, Group Accident, Critical Illness and Hospital Indemnity Insurance
Employee Discount Program
Other:
Early Access to Earned Wages
Tuition Assistance
Relocation Assistance
Paid Time Away
Special Employee Rates at NMMC Wellness Centers
#J-18808-Ljbffr