Revenue Cycle Specialist, Full Time (Partially remote)

Location: Nashville, TN

 Status: Regular Full Time

Days: Monday - Friday 

Hours: 40/week 

SUMMARY

Primarily responsible is to assist the Revenue Cycle team where needed (Hospice and Palliative Care) in billing, payments posting, and claim follow-up.  Assist with initial referral/insurance tasks.  ICD-10 Coding and CPT Compliance reviews. 

ESSENTIAL DUTIES AND RESPONSIBILITIES  

1. Assist when needed to generate patient claims through EMR billing system.  Upload EMC file to clearinghouse as soon after target bill date and errors/holds are clear.  Continue review of unsubmitted/errored claims to avoid timely filing to the payers.
2. Assist AR team with commercial insurance/TennCare, hospice per diem, pro fee and palliative care claims, self-pay, Residence and NH Room & Board billing. Review claims prior to submission for compliance with insurance regulations.  (all or in part based on assigned duties)
3. Trained on process to post non-Medicare payments and balance with daily deposits.  Follow up on incorrect, partial payments or unpaid claims. (if applicable to assigned duties)
4. Assist when necessary with physician visits entry related tasks prior to month end close.
5. Access admission report (Hospice), or spreadsheet (PC), and enter appropriate ICD-10 codes into EMR based on physician CTI (Hospice) or Clinician note (PC).  (if applicable to assigned duties)
6. Using pre-bill CPT audit sample to complete compliance review through physician coding compliance software.  Run monthly/quarterly report and forward to RC Director.  (if applicable to assigned duties)
7. Report individual finds to the physician for review and resolution of the coding discrepancy.  After physician review/approval make coding changes and note in EMR. Report to billing staff when claim can be released. (if applicable to assigned duties)
8. Submit write off requests with documentation after all collection efforts have been exhausted to the RC Director.
9. Notifies RC Director of any problems with patients’ claims, or insurance companies.
10. Other duties may also be assigned.

CONTINUING EDUCATION

The agency requires this position to complete 6 hours of continuing education per year covering topics that will contribute to improvements in carrying out the above responsibilities.  Regulatory agencies may require some disciplines to have additional hours to be licensed or certified. 

QUALIFICATIONS 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including meeting the required competencies. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

EDUCATION and/or EXPERIENCE

High School diploma required. One-year college or technical school: one to three years related experience or equivalent combination of education and experience. Must be a certified coder currently or within the past two years. 

CERTIFICATES, LICENSES, REGISTRATIONS

If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law. 

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel.  The employee frequently is required to sit and talk and hear.  The employee is occasionally required to stand; walk; reach with hands and arms; and stoop, kneel, crouch, or crawl.  The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision and the ability to adjust focus. 

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally exposed to moving mechanical parts and infectious diseases.  The noise level in the work environment is usually moderate. Usually in a general office setting. 

CONTINUING EDUCATION

The agency requires this position to complete 6 hours of continuing education per year covering topics that will contribute to improvements in carrying out the above responsibilities. Regulatory agencies may require some disciplines to have additional hours in order to be licensed or certified.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including meeting the required competencies. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

High School diploma required. One year college or technical school: one to three years related experience or equivalent combination of education and experience.