Revenue Cycle Transaction Specialist

SECTION 1: Job Summary (Summary of the basic functions of the position)Responsible data entry for medical billing from insurance companies (payors) and patients. Serves as aliaison between practices, clinics, the business office, payors, and patients. Establishes and maintainscontacts with payor accounts representatives. Initiates telephone contact and answers all calls pertainingto accounts. Maintains accurate information regarding patient accounts receivable. Maintains strictconfidentiality for all patient accounts. Follows approved processes, policies and procedures in executingjob duties.SECTION 2: Duties and Responsibilities (Responsibilities necessary to accomplish job functions)Responsible for accurate and timely posting of patient and insurance transactions including charges, payments, adjustments and refunds into the practice management system.Processes patient and insurance refunds and issue refund checks to appropriate partiesKeys data into computer to maintain billing records and prepare insurance form with data such as names of insurance company and policy holder, policy number, and physician diagnosis.Contacts insurance company to verify patient coverage and obtain information concerning extent of benefits.Generates appropriate paper work, including insurance claim forms (original and re-filed) and collection letters, mails monthly statements to patients.Reviews insurance claim forms for accuracy, retrieving and attaching appropriate dictation for claim, as needed.Reviews insurance payments (Explanation of Benefits EOBs), including Medicare and Medicaid payments for accuracy in account information and demographics.Determines adjustments of claims paid at the out-of-network rate to in-network rates, and processeswrite-offs on these adjustments.Answers patients' questions regarding statements and insurance coverage, answers telephone in a prompt, courteous, and helpful manner, screening calls, directing calls, providing information, answering questions, and taking accurate messages.Responds to all inquiries received from patients and payors either by telephone or written requestFollows-up on unpaid insurance claims after denial, to obtain settlement of claim.Establishes and maintains contacts with payor accounts representatives.Reviews accounts receivable activities and calls on outstanding balances or claims.Handles transactions necessary on discharged patients.Completes and files all necessary paperwork for services rendered, i.e., charge tickets, patient forms, medical records, etc.Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.Performs other duties that may be necessary or in the best interest of the organizationSECTION 3: Experience RequirementsThree (3)+ years of work experience in medical billing and accounting experience.SECTION 4: Knowledge, Skills and Abilities RequirementsThorough knowledge of medical billing procedures and medical insurance, including credit and collection procedures required.Thorough knowledge of Medicare rules and regulations.Thorough knowledge of medical accounts receivable collection procedures, including knowledge of insurance correspondence required.Detail oriented, professional attitude, reliableManagement and organizational skills to support the leadership of this functionAbility to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretationsInterpersonal skills to support customer service, functional, and team mate support needsAble to communicate effectively in English, both verbally and in writingMathematical and/or analytical ability for basic to intermediate problem solvingBasic to intermediate computer operationProficiency with Microsoft Excel, Word, and OutlookSpecialty knowledge of systems relating to job functionKnowledge of state and federal regulations for this position; general understanding of HIPAA guidelinesSECTION 5: Supervisory Responsibilities:This position has no supervisory responsibilities.JOB CODE: #INDHP

Created: 2025-02-14