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    Revenue Cycle Coordinator | Usa

    Advantum Health Logo
    2+ years
    Not Disclosed
    Remote, USA
    10 Nov. 13, 2024
    Job Description
    Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

    Job Title: Revenue Cycle Coordinator

    Position Summary:
    The Revenue Cycle Coordinator ensures the daily management of the contracted Revenue Cycle Management services for a client in Maryland. Key responsibilities include payor enrollment activities, insurance verification, precertification, coding, claim submission and denials management, accounts receivable follow-up, payment posting, patient billing cycle management, collections efforts, and financial counseling. This position works closely with Advantum Health and client team members to support an effective and efficient revenue cycle process for all products and services rendered.

    Responsibilities:

    • Supports Advantum Health’s vision, mission, values, and policies, and adheres to all procedures set by both the employer and the client.
    • Maintains confidentiality for all information, including Protected Health Information (PHI).
    • Ensures compliance with OSHA, HIPAA, IT policies, patient safety standards, and other organizational requirements.
    • Collaborates with Advantum Provider Enrollment and the client to complete provider and facility enrollment activities, including CAQH, NPPES, Medicare, Medicaid, and commercial insurance carriers.
    • Configures billing software applications to reflect enrollment activity and completes system maintenance for remittance advices and electronic funds transfer setup with insurance carriers.
    • Maintains the client billing fee schedule based on the Medicare fee schedule and coordinates updates for procedure and diagnosis changes.
    • Ensures accurate claim adjudication and payment by maintaining current insurance carrier allowable schedules in the billing software.
    • Manages charge entry lag activity and coordinates the biannual evaluation and management claim/documentation audits.
    • Communicates with insurance carriers regarding billing protocols and incoming correspondence.
    • Coordinates payment posting by insurance carriers and manages claims denials, including appeals, reconsiderations, and trend reporting.
    • Manages insurance-based accounts receivable within pre-established goals and handles credit balances and insurance refund requests.
    • Creates and maintains revenue cycle policies and procedures, including standard operating procedures.
    • Oversees patient insurance verification, precertification, and authorization activities for all products and services.
    • Coordinates financial responsibility obligations and ensures prepayments are made prior to services being rendered.
    • Administers the patient billing cycle, including statements, soft collections, and the patient collections program.
    • Manages the Maryland Trauma Fund and patient financial hardship programs.
    • Develops and maintains patient payment programs, coordinates patient-related payment posting, and oversees the patient call center for billing inquiries.
    • Collaborates with Finance on time-of-service payment reconciliation and performs additional duties as assigned by the client in collaboration with Advantum management.

    Required Skills:

    • In-depth knowledge of accounts receivable, insurance payment policies, and insurance requirements/procedures.
    • Strong attention to detail and problem-solving ability.
    • Ability to work independently and think critically.
    • Proficient in mathematical functions.
    • Strong communication skills to interact with patients, client staff, and management.
    • Excellent customer service skills.
    • Computer proficiency, including data entry and basic PC use.

    Qualifications:

    • Minimum of 5 years of medical revenue cycle leadership experience.
    • Certification in Coding preferred but basic coding training required.
    • Undergraduate degree in a related field required.

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