Location
Northbrook, IL | United States
Job description
The Revenue Cycle Lead , reporting to the Revenue Cycle Manager, acts as a subject matter expert for all revenue cycle functions and activities. This position is responsible for ensuring compliance with third party payor requirements as well as all applicable state/federal laws and regulations.
Only candidates able to commute to the jobs on-site location (Northbrook, IL) Monday through Friday 5 days a week will be considered. Remote work is not an option.
Responsibilities
- Acts as subject matter expert for assigned revenue cycle areas, ensuring optimal revenue collection and patient satisfaction with the billing experience and ensuring compliance
- Performs RCA (Root Cause Analysis) to resolve problems affecting the revenue cycle and develop solutions to implement.
- Contacts insurance regarding claim status, denials, underpayments, and recoupments
- Read and understand insurance eligibility and benefits
- Research & resolve outstanding claim issues and patterns
- Submit Appeals for Denied Claims
- Submit Medical Records and other documentation requests to insurance
- Ability to work on 50+ denied claims per day on the phone and provider portals
- Ensures compliance with USAVC policies and procedures, health plan requirements, and federal and state laws and regulations
- Additional duties as assigned
Requirements
- Bachelor's Degree plus 3 or more year's previous experience in medical collections, or an equivalent of experience and education, required
- Minimum of 2 years prior revenue cycle experience required
- Experience with Aetna, BCBS, UHC, Medicare, and Medicaid denials required
- Experience with multi state insurance denial collecting a preferred
- Familiar with provider portal eligibility and claim tools. Example: Availity, Navinet required
- Ability to read and understand insurance remittance including denial and remark codes required
- Ability to understand the remittance denial codes and get claims reprocessed required
- Strong personality and willingness to rebuttal with insurance claims representatives to overturn denials
- Exceptional customer service and phone etiquette
- Thorough understanding of physician billing practices and procedures, including knowledge of state, local and federal laws
- Strong knowledge of reimbursement rules and methodologies for both physician and ambulatory surgery billing
- Strong knowledge of Microsoft Excel (VLOOKUP and Pivot Tables)
Benefits
- Health
- Dental
- Vision
- 401K & match
Job tags
Salary
