Revenue Cycle Specialist

• Performs retrospective coding review of denied charges for physician services.
• Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing.
• Make corrections to charges when necessary.
• Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization.
• Performs extensive follow-up to investigate and resolve payment denial trends.
• Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation.
• Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals.
• Ensures denial reviews are conducted in a timely manner.
• Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors.
• Participates in annual and on-going mandatory compliance training.
• Fulfills Continuing Education Units necessary to maintain certification status.
• Assists in training current and new employees on the use of systems and departmental policies and procedures.
• Performs other related duties as assigned.

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Revenue Cycle Specialist – Revenue Integrity, Pathology