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Revenue Cycle Specialist II
University HospitalsSubmits and resolves medical claims while adhering to compliance and departmental policies in a remote setting.
About the role
Key responsibilities & impact- Position responsible for submitting and resolving medical claims moderate to high complexity.
- Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.
- Responds to requests from management, staff, or physicians in a timely and appropriate manner.
- Maintains patient and physician confidentiality and professionalism at all times.
- Follow department policies and procedures to ensure accurate and timely claim resolution.
- Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
- Attends and participates in team meetings.
- Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
- Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
- Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
- Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
- Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
- Documents accounts with clear and concise verbiage in accordance with departmental procedures.
- Reviews and responds to correspondence and inquiries received.
- Meets and exceeds team productivity and quality standards.
- Takes the lead on special projects.
- Participates in staff training.
- Reviews complex claims issues for resolution and recommends process improvements.
- Performs other related duties as assigned.
Requirements
What you’ll need- High School Equivalent / GED (Required)
- Associate's Degree (Preferred)
- Bachelor's Degree (Preferred)
- 1+ years medical billing / claim experience (Required)
- Experience with medical billing software (Preferred)
- Must have a working knowledge of claim submission (UB04/HCFA 1500) and third party payers. (Required proficiency)
- Knowledge of procedural and ICD10 coding. (Required proficiency)
- Basic knowledge of medical billing terminology. (Required proficiency)
- Detail-oriented and organized, with good analytical and problem solving ability. (Required proficiency)
- Notable client service, communication, and relationship building skills. (Required proficiency)
- Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
- Must have strong written and verbal communication skills. (Required proficiency)
- Demonstrated ability to use PCs, Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency)
Benefits
Comp & perks- Complies with all policies and standards
- Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical billingclaim submissionUB04HCFA 1500ICD10 codingmedical billing terminologyclaims resolutionaccounts receivableanalytical skillsproblem solving
Soft Skills
detail-orientedorganizedclient servicecommunicationrelationship buildingindependentteam playerfast-paced environmentwritten communicationverbal communication
Certifications
High School EquivalentGEDAssociate's DegreeBachelor's Degree