NOPG REV CYCLE SPECIALIST - PROFESSIONAL BILLING SERVICES
Status: Full Time
Shift: 8:00am to 5:00pm - Monday - Friday
The Revenue Cycle Specialist (RCS) is responsible for partnering with providers and clinic operations staff to support the North Oaks Clinic Revenue Cycle. The RCS is responsible for understanding and optimizing the revenue cycle for their specific clinic location. This requires a comprehensive understanding of the areas that can hinder optimal performance of revenue capture, including practice management issues such as registration, scheduling and denial management, but also an in-depth understanding of charging, coding, billing, and charge update/claim edit work-queues. The RCS also provides local support to providers and clinic staff for CPT, HCPCS, and ICD-9-CM coding.
1. Minimum of two years experience in Physician billing and coding, or equivalent.Minimum of one year experience in medical record chart documentation review.Good knowledge of CPT/HCPCS and ICD-9 coding guidelines required. Must demonstrate a thorough understanding of the front and back end revenue cycle components in a physician practice.2. Specialized or Technical Education Required:High school diploma or equivalent.Preferred completion of a medical billing and coding program.Demonstrated knowledge of Anatomy and Physiology, medical terminology, disease processes.Basic knowledge of reimbursement methodologies and conventions.Knowledge of rules and guidelines for current coding classifications.Demonstrated ability to understand the clinical contents of a health record.Demonstrated ability to communicate with physicians in order to clarify diagnoses and procedures coding and documentation requirements, including proper sequencing.Basic knowledge of physician clinic based revenue cycle.Basic knowledge of professional services coding and billing in a multi-specialty environment.Basic knowledge of government and other payer coding, billing and collection rules and regulations.Requires strong verbal and written communication skills.Must be detailed oriented. Possess the ability to perform duties with minimum direct supervision; the ability to organize and record information appropriately and solve problems independently.Ability to work under stress and to meet imposed deadlines.3. Manual or Physical Skill Required:Requires manual dexterity sufficient to operate keyboard, telephone, copiers, and such other office equipment as is necessary. Vision must be correctable to 20/40 and hearing must be in the normal range for telephone contact. It is necessary to view and type on computer screens for long periods. Work may also require sitting for long periods of time as well as stooping, bending and stretching for files, supplies, or other materials.4. Physical Effort Required:Strength: LightPush: OccasionallyPull: OccasionallyCarry: OccasionallyLift: OccasionallySit: FrequentlyStand: OccasionallyWalk: Frequently
1. Key, process, edit, review, correct, balance and post all clinic charges within one business day from date of service, whether manual or electronic, processing claims edits for accuracy as well as insurance and coding compliance.2. Receive hospital charge/service information from the provider and utilize coding guidelines to assign the appropriate CPT and/or HCPCS Level II and ICD-9 codes.3. Abstracts CPT, HCPCS II and ICD-9 from patient/medical records.4. Query physicians and other health care practitioners when additional information is needed to complete accurate billing and coding tasks.5. Works with Clinic Coders on services that require a higher level of coding expertise such as surgical procedures.6. Maintain a system that ensures that all charges/services are coded and keyed.7. Keeps supervisor apprised of matters regarding billing, coding, and charge entry.8. Key, process, edit, review, correct, balance and post all hospital, home health, nursing home and/or any other outside agency/clinic charges within one business day from date that documentation was received from the providers, outside agency/clinic or coders, processing claims edits for accuracy as well as insurance and coding compliance.9. Complete the Daily Batch Log in order to maintain a consistency and accuracy in the keying of all charges and ensuring that all batches are posted.10. Complete the Audit Performance Indicator (API) Log for errors found within the charge process, in order to track and trend said errors which will assist management in determining educational needs.11. Maintain a system in order to keep track of charges that cannot be posted due to errors, following through to ensure that errors are corrected, and ensuring that corrected charges are posted.12. Obtain, notify and send to the Clinic Central Billing Office (CBO) all paper documentation that is necessary for the completion of a charge to the payers, which includes but is not limited to, office notes, test results/reports, etc., via email, fax, interoffice mail, etc.13. Notify the Clinic Central Billing Office (CBO) via email when electronic documentation is necessary for the completion of a charge to the payers. The CBO will retrieve said documentation from the patient’s electronic medical record (EMR).14. Reconcile the charge batch, whether manual or electronic, with the providers/nurse/lab daily schedules in order to ensure that all charges are being captured.15. Reconcile the charge batch, whether manual or electronic, to the providers office notes in order to ensure that all charges/services have been documented while maintaining a system in which to report and monitor those provider office notes that are missing or incomplete.16. Ensure that medical justification is obtained prior to charges being posted.17. Obtain revenue and accurate cash flow by working with Managers/Supervisors and Providers for the capture of all charges while adhering to billing, coding, collection and compliance guidelines.18. Maintain a current working knowledge of the CMS 1500 billing guidelines, CPT codes, HCPCS codes, Modifiers, ICD-9 Diagnosis Codes, Correct Coding Initiative (CCI) edits and Medical Necessity edits that are needed to ensure proper billing, collections and compliance guidelines.19. Revenue Cycle Specialist are not allowed to change CPT codes, HCPCS codes, and/or diagnosis codes on charges without intervention from the provider and the patient’s chart being updated to reflect the change.20. Educate and offer feedback to physicians, other health care practitioners, and staff as needed to ensure that documentation is complete, accurate, and compliant with guidelines, maintaining an exceptionally high level of professionalism.21. Analyze the CBO Denial Log for the clinic specific denials and take the appropriate action necessary to resolve the denial, whether it is backing-off and re-keying a charge, adding a modifier, correcting the diagnosis, etc., while ensuring that the provider is included in the corrections as need be. Notate on the CBO Denial Log all pertinent information pertaining to the denial and email the appropriate CBO employee that denial is resolved.22. Analyze the CBO Pre-Bill Denial Log for the clinic specific pre-bill denials and take the appropriate action necessary to resolve the pre-bill denial, whether it is backing-off and re-keying a charge, adding a modifier, correcting the diagnosis, etc., while ensuring that the provider is included in the corrections as need be. Notate on the CBO Pre-Bill Denial Log all pertinent information pertaining to the pre-bill denial and email the appropriate CBO employee that pre-bill denial is resolved.23. Retrieve the Credit Balance Log that is sent via email from the CBO. Analyze the log for the clinic specific credit balances and take the appropriate action necessary to resolve the credit balance, whether it is keying a charge, transferring the co-pay, etc., while ensuring that the provider is included in the corrections as need be. Notate on the emailed Credit Balance Log all pertinent information pertaining to the resolution of the credit balance and email the corrected Credit Balance Log to the appropriate CBO employee.24. Monitor and adhere to deadlines that are set forth in the completion of the Denial, Pre-Bill Denial and Credit Balance Logs.25. Work with the Clinic Manager/Supervisor and/or CBO in order to resolve patient complaints pertaining to billing issues ensuring that the patients chart, whether paper or electronic, is updated accordingly.26. Work with hospital departments, such as Patient Financial Services (PFS) and Health Information Management (HIM), in order to resolve hospital denials and patient complaints while ensuring that the provider is included in the corrections as need be.27. Update responsible party and/or patient demographic information that is received, which includes but is not limited to, name, address, telephone numbers, insurance, relationship to insured, etc.28. Assist clinic supervisor and/or manager in ensuring that the daily deposit reconciliation policy is followed on a daily basis.29. Works independently following established policies, procedures, and practices.30. Ability to work under stress and to meet imposed deadlines.31. Maintains and demonstrates in their daily interaction with others a positive working relationship with the various levels of staff.32. Attend clinic and department staff meetings to disseminate information and to become familiar with operational issues within the clinic.33. Communicate effectively by expressing ideas clearly, actively listening and always following appropriate channel of communication.34. Demonstrate a responsiveness to others ensuring complete follow-up on matters requiring additional attention.35. Must maintain a professional demeanor and confidentiality at all times whether in the clinic, hospital or community.36. Enhance professional growth and job related development through in service meetings, educational programs, conferences, etc.37. Attend staff meetings and participate in committees as required.38. Perform other duties to assist in the efficient operation of the clinic division.39. Follow North Oaks Health System compliance program and federal and state regulatory guidelines.