Revenue Cycle Management Account Manager
Employment Type: Full-Time
Our team is committed to enhancing physician and patient quality of life through Elation, a SaaS cloud-based clinical platform. Since inception, we've been focused on building a delightful world-class experience that empowers physicians to deliver phenomenal care to patients and we plan to keep it that way by continuing to help them overcome challenges. We've enjoyed considerable growth and are now looking for an exceptional individual to join our team as a Revenue Cycle Billing Specialist.
The Revenue Cycle Billing Specialist has a crucial role in Elation's service operations by owning the medical billing process for providers on our platform. The Revenue Cycle Services team is responsible for the day-to-day processes to create, track, and manage medical claims and resolution of unpaid and underpaid claims. Each Specialist will also be responsible for identifying recurring claim patterns and suggest operational changes to avoid unpaid or underpaid claims in the future. The ideal candidate must have a strong command of the health insurance reimbursement and claim adjudication processes.
We are looking for a detail-oriented individual with the ability to work in a fast paced, rapidly changing environment. Signals of success include driving down the time it takes to collect on open A/R, injecting process improvement into the existing billing operations workflows, and ensuring a high-quality, consistent billing experience for all Elation customers.
As a Revenue Cycle Billing Specialist, you will ...
* Communicate effectively and professionally with insurance company representatives regarding inquiries on billed claims, denied claims, and claims that are inaccurately processed to secure payment on balances outstanding
* Communicate with insurance claim representatives to clarify billing issues and facilitate timely payment, with little disruption to Elation practices and patients
* Work with payers to follow-up on unpaid and underpaid claims to secure payment on outstanding balances, including adherence to timelines and response dates
* Conduct regular reviews of unpaid claim patterns and make recommendations to improve operational efficiency and reduce the occurrence of rejections/denials
* Research payer contract terms and create standardized workflows for managing denials, matching payer processes to denials criteria
* Analyze claims responses received from commercial insurance companies and provide management reporting on results
* Identify performance metrics by payer and identify trends
* Work with front and back end billing teams to identify corrective actions needed
* Proactively monitor adjudication results and report on compliance with contracts to optimize collections
* Develop and maintain reimbursement expertise on the company's products and services
* Review patient medical records and utilize clinical and regulatory knowledge as well as knowledge of payer requirements to determine why cases are denied and whether an appeal is required
* Develop well-supported, patient specific appeal arguments to submit to payers, where an appeal is warranted (e.g., medical necessity, prior authorization, experimental)
* Regularly review credit balances and complete insurance or patient refunds in a timely manner
* Accurately and precisely document actions taken to track and resolve billing issues and collect reimbursement
* Identify opportunities within current-state billing and collections processes and develop/execute on alternative opportunities to automate or streamline existing processes
* Minimum 3 years of experience with health insurance and billing operations for a provider's office (Primary Care a plus)
* Significant knowledge of regulatory and payer requirements for claims submission, reimbursement, and reason(s) for denials
* Exhibit strong problem-solving skills in resolving claim issues both through verbal and written communications
* Proven record of constructing convincing appeals arguments that are sound and supported by clinical evidence that is related to patients' specific clinical attributes
* Capability of producing high-quality, high-volume work by leveraging self-motivation, prioritization, and initiative
* Demonstrated ability to deliver positively on challenging work objectives, including meeting daily, weekly, and/or monthly productivity metrics
* Ability to communicate effectively and professionally with customers
* Comfort and capability to utilize communication tools including instant messaging and video conferencing (e.g. Slack and Zoom) to enable virtual work collaboration and maintain a consistent work presence
* Ability to maintain confidentiality of patient data and medical records in compliance with HIPAA regulations
* Capability to maintain a secure work area, conforming to HIPAA guidelines
* Passionate team player who's eager to learn quickly in a supportive environment