North Mississippi Health Services

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.

Job Functions

Billing & Follow Up:

• Processes Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format.
• 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.
• 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.
• Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
• Analyzes denials to determines reason they occurred.
• Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager.
• 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.
• Manages paid claims to resolve underpaid accounts.
• Develops strategy for appeal, appeal follow-up and/or reprocessing accounts.
• Analyzes underpayments to determine reason they occurred.
• 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.
• 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.
• Assists in preparation of monthly variance reports and other variance reports as requested.

Regulation

• Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues. **QUALIFICATIONS** **Education**
• Education Level****Education Details****Required/Preferred**

Bachelor's Degreein Business, coding or equivalent fieldRequired

Or

Associate's DegreeWilling to consider 4 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degreeRequired

Or

High School Diploma or GED EquivalentWilling to consider 8 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degreeRequired

• Licenses and Certifications**
• Licenses and Certifications****Licenses and Certifications Details****Time Frame****Required/**
• Preferred**
• Work Experience**
• Number of Years****Work Experience Details****Required/**
• Preferred**

1-3 YearsClaims, Billing/ Follow-Up, Or Revenue Cycle ExperienceRequiredAnd

1-3 yearsExperience/knowledge of managed care reimbursement methodology including ICD-10, CPT-4 and/or HCPCS and DRGsRequired

• Knowledge Skills and Abilities**
• Knowledge, Skills, Abilities****Required/Preferred****Proficiency**

Excellent Analytical And Problem-solving SkillsRequiredN/A

Good organizational and communication (written and verbal) skillsRequiredN/A

Excellent Interpersonal SkillsRequiredN/A

Computer skills with strong Microsoft Office, Outlook, Third Party Payer websitesRequiredN/A

Must be able to research, analyze and communicate payer trends to identify reimbursement and training issuesRequiredN/A

Must professionally and effectively communicate with third party carriers, vendors, and hospital contacts to promote contractual complianceRequiredN/A

Must provide input and help design payer report cards in conjunction with contracting, managed care, and other revenue cycle departmentsRequiredN/A

Must serve as member of the Denials CommitteeRequiredN/A

Must conduct training sessions with Billing and Follow-up staff as neededRequiredN/A

Must have effective negotiating skills, including the ability to resolve difficult claims issuesRequiredN/A

Must be able to gather and share information with knowledge, tact, and diplomacyRequiredN/A

Must have extensive contact with: patients, payers, physician office staff, coding staff, Credentialing, Case Management, various Department heads, and all staff within the departmentRequiredN/A

• SCOPE**

Freedom To Act

• Problem Solving:**

Impact

• Financial Responsibility:**
• Sales Revenue Target Responsibility:
• Approval Responsibility:
• P & L Responsibility:
• Assets Controlled:
• Controllable Expenses (e.g., Payroll and other budgeted items):
• Total Financial Responsibility: Budget Responsibility
• Primary Budget Responsibility:
• Shared Budget Responsibility:

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