Revenue Operations Coordinator

CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.

• Role Title: Revenue Operations Coordinator I
• FLSA Category: Non-exempt
• Role Location: Boynton Beach FL

Reporting Relationships:

This position reports to the Revenue Operations Supervisor/Manager.

Role Summary and Responsibilities:

The Revenue Cycle Coordinator I will be responsible for supporting management in maintaining, improving, processing, and evaluating the billing and collection of accounts receivable for the Medical Group and/or resolve complex payer issues to completion daily. This may encompass working on the receivable of multiple practices and will comprise the receivable of multiple third-party payers and supporting management in the execution of Revenue Cycle collection duties.

Key Responsibilities / Essential Functions:

• Complete A/R resolution, corrected claims, appeals.
• Maintains data in billing management system (i.e., updating current and adding new demographic information and ensures that documentation entered is accurate and complete.).
• Interacts / communicates effectively with various department staff and assists customer service inquiries both internally and externally.
• Contacting payors for claims status and dispute resolution.
• Charge capture, collections processing and payment posting.
• Works with all practices to ensure charges are entered and processed timely.
• Coordinates with practices to ensure charges in “hold” status are worked and cleared of any problems in a timely manner.
• Ensures claims are processed timely for prompt reimbursement.
• Ensures claims are submitted with payable diagnosis codes.
• Prepares and completes claims for government payers, commercial insurance, and third-party organizations.
• Responsible for entering patient demographics for diagnostic charge tickets.
• Responsible for posting lab charges.
• Searches for payable diagnosis codes.
• Communicates with office to obtain required information.
• Work all claims on hold.
• Work missing slips; create claims reviewing for coding accuracy, ensure correct ICD 10 codes, CPT codes and modifiers used.
• Review claims in AR cycle (to ensure claims process timely.
• Appeal claims as necessary and on a timely basis.
• Oversee collection of patient balances.
• Work with local hospitals for collection of monies for contracted services.
• Ability to handle interruptions and unpredictable situations.
• Maintain strict confidentiality.
• Ability to document work in progress at the request of physician and practice manager.
• Excellent oral and written skills dealing with physicians, practice manager, team members, hospitals, and central billing office.
• Excellent organization skills.
• Answers patient calls and answers billing questions.
• Prepares and reviews claims for electronic billing submission.
• Investigates claims denied by insurance plans.
• Identifies, corrects, and resubmits incorrect claims.
• Reviews remittance advice for payment errors, denials and under payments.
• Maintains patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Responsible for answering phones.
• Front desk check in and patient scheduling.
• Works with all practices to ensure charges are entered and processed timely.
• Coordinates with practices to ensure charges in “hold” status are worked and cleared of any problems in a timely manner.
• Ensures claims are processed timely for prompt reimbursement.
• Ensures claims are submitted with payable diagnosis codes.
• Prepares and completes claims for government payers, commercial insurance, and third-party organizations.
• Responsible for entering patient demographics for diagnostic charge tickets.
• Responsible for posting lab charges.
• Searches for payable diagnosis codes
• Communicates with office to obtain required information.

Non-Essential Functions:

• Other duties, as assigned.

Qualifications:

• High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.
• CCS-P or CPC certification a plus.
• Must have a minimum of 3 years of experience with medical billing.
• Pediatric or Primary Care billing experience preferred.
• Experience with GE Centricity preferred but not required.
• High level of organization and attention to detail.
• Customer service skills with both patients and insurance representatives.
• Experience with modifiers.
• Experience with Electronic Medical Record Systems required, Centricity and Phreesia preferred.
• Knowledge of business and accounting processes.
• Excellent customer service and communication skills.
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Knowledge of medical terminology is likely to be encountered in medical claims.
• Excellent problem-solving skills.
• Intermediate Computer Literacy with basic knowledge of office procedures and business machines.
• Knowledge of CPT codes, ICD 10, and Athena.
• Prior experience in a medical office setting.
• 1-year related experience and/or training; or equivalent combination of education and experience.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
• Knowledge and experience with Athena, EHR and Misys Tiger.
• Knowledge of accounting, healthcare, and general office procedures preferred.
• Working knowledge of collection processes and insurance verification and pre-certification processes.
• Requires ability to understand, interpret, evaluate, and resolve basic customer service issues.
• Intermediate knowledge of accounting principles which directly impacts the accounts receivable that may include debit and credit transactions; charge transfers; contractual allowances and adjustments and financial class changes.
• Knowledge of the state and federal reimbursement and regulatory guidelines to ensure compliance with State regulations regarding patient and insurance billing issues, preferred.
• Knowledge of medical terminology.
• Requires knowledge of common revenue cycle accounts receivable terms, common business practices, and statute of limitations as it pertains to billing, appeals, payer requests, payments, retractions, and EOBs.
• Requires knowledge of billing, collection, and telecommunications software.
• Understands HCPC and/or CPT coding issues that could impact a claim.
• Requires knowledge of up-to-date HIPAA and HITECH rules and regulations.
• Demonstrates ability to assist in mentoring others regarding the department’s payers and revenue cycle processes.
• Ability to work the receivable of multiple facilities with experience, knowledge, and skills that are transferable to other tasks and assignments.
• Understands common terms used daily in carrying out tasks.

Physical Requirements:

• Mainly sedentary.
• Sitting at the desk most of the day.
• Standing or walking less than two hours per day.
• Lifting no more than ten pounds on rare occasions.
• Must be able to work at a computer and answer phone calls on a regular basis.

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.

CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).

We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.

Tagged as: Revenue Operations, RevOps