Job Functions, Duties, Responsibilities and Position Qualifications:
The purpose of the Revenue Cycle Specialist is to ensure that all aspects of the Revenue Cycle process for molecular and genetic testing claims process within standard SOP and Compliance guidelines. Monitor collections to ensure all accounts receivable expectations met within department's set guidelines and contracts.
This will be a full time position supporting the Sonic Healthcare USA ThyroSeq Laboratory (760 Westchester Avenue, Rye Brook, NY 10573).
- Pre-screen each molecular test that currently requires prior authorization (PA) in the organization's PA system; following established SOP and workflows.
- Initiate PA request for specific payer following processes and workflows established by the department.
- Initiate Referring PA request with appropriate physician and follow-up until PA obtained.
- Follow-up on direct PA request with payers to ensure PA obtained timely.
- Research and respond to all complex matters received through billing correspondence and insurance carrier denials.
- Review insurance remittances for allowances and rejections, and respond with corrective action using industry modifiers, MUE edits, and medical necessity denials.
- Prepare correspondence and attach proper documentation for the appeals process or resubmit corrected claims using clearinghouse utility within the appropriate time limit.
- Identify payer trends and work with insurance/provider representative or management to bring to resolution.
- Handle all inbound calls regarding patient phone inquiries concerning balances, payment plans, credit card payments, patient pricing, updating patient demographics, re-billing insurance companies and general customer concerns.
- Access to payer web portals to review claim status, check eligibility and benefit coverage.
- Evaluate and respond to all aspects of written billing inquiries from patient or their legal representative or clients including but not limited to billing insurances, updating invoices, troubleshooting billing issues and complex customer complaints.
- Process payments, adjustments, refunds, transfer bills and mail returns.
- Review special circumstances including patients seeking patient hardship, bankruptcy and collection agency referrals.
- Ensure all credit balances are resolved and refunds generated in a timely manner.
- Maintain and update internal insurance database including timely filing limits, appeal rights for billing department reference and instruction.
- Support sales team and request for information as it pertains to patient billing.
- Additional duties as assigned.
- Create and maintain department SOP's and workflows as directed by Management.
- High School diploma or equivalent required; college degree preferred.
- At least three (3) years' experience in healthcare accounts receivable environment preferably in a laboratory setting; knowledge of medical terminology, billing practices and appeals experience a plus.
- Demonstrate proficiency in Microsoft Word and Excel.
- Adhere to Medicare, Medicaid Compliance and HIPAA guidelines in relation to PHI information.
- Exceptional analytical and organizational skills.
- Superior time management and critical thinking skills.
- Ability to work under pressure and achieve goals.
- Strong written and verbal communication and interpersonal skills.
- Dependable, flexible and adaptable in all aspects of work.
- Excellent data entry skills.
Physical Demands and Work Environment:
Physical Requirements: Requires light to medium lifting and carrying of objects weighing up to 50 pounds. Requires manipulation of tools, objects, and equipment using the following physical motions: pushing, pulling, lifting, reaching above shoulder height, grasping with both hands, pinching with thumb and forefinger, twisting with hand and wrist, climbing under, lifting up, lifting down, and reaching under. Routinely requires coordination of two or more physical operations. Routinely requires visual discrimination of color, size, shape, and motility. Requires the ability to hear audible alarms on temperature monitored equipment and automated analyzers.
Environmental Demands: Works in temperature controlled environment with constant exposure to biological and chemical hazards. May be required to operate fire and safety equipment or follow other safety procedures in an emergency. May be required to work with time constraints and in crisis situations.
Scheduled Weekly Hours:
CBL Path, Inc.
Sonic Healthcare USA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.