ResolutionRCM, a QHR Health company is seeking strong all payer revenue cycle analyst with rural hospital experience, especially Critical Access Hospital experience. Must be knowledgeable in the areas of AR Follow-up, appeal writing, root cause analysis, and Billing and Collections. The primary responsibility for this position is to expedite submission to clean claims to increase payer reimbursement and reduce AR days for our rural hospital clients across the nation. The ideal candidate will have a demonstrated record of accuracy and efficiency and must be proficient in their knowledge of billing regulations, claim form requirements and processes for payer sources, government and non-government.
Required Skills and Experience
- Accurately researches and updates information for payer claims such as patient information, insurance ID, diagnosis and treatment codes and modifiers, and provider information.
- Prepares and submits clean claims to various insurance companies either electronically or by paper.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Accurately reports barriers to billing and claim reimbursement via Obsidian or other company-defined Cause and Action recording tool, escalates all open claims to their immediate supervisor when claim resolution is beyond their scope.
- Provides precise documentation of all actions taken on accounts, according to the company’s standard template.
- Obtains required claim information to clear an average of 150 account billing edits daily.
- Researches and resolves claim holds, denials, referrals and limits to patient coverage.
- Verifies patient benefits, eligibility and coverage as needed.
- Exhibits a clear understanding of the 5Ws (Who, What, Why, Where, When), and uses them correctly when notating accounts.
- Utilizes knowledge of basic CMS guidelines, payer contracts and state regulations for timely filing and AR collections.
- Researches ICD 9/10 diagnosis and CPT/HCPCS codes from online services or uses traditional coding references when needed.
- Communicates effectively with immediate supervisor to identify areas of opportunity that will improve client performance results and increase productivity.
- Meets (or exceeds), tracks, and accurately reports productivity statistics daily.
- Follows up with HIM and/or ancillary departments for needed information
- Other duties as assigned as related to the analyst position.
- The successful candidate will have a minimum of 3 years current hospital business office billing and collection experience.
- Work experience preferably includes Medicare DDE, DDE error resolution (RTP) and Medicaid Web Portals.
- Experience in claims reconciliation and balancing to all client systems from hospital billing and clearinghouse systems.
- Shows knowledge, skills and ability to upload billing files into electronic applications for processing and error resolution.
- Able to work in a fast-paced, changing and high growth environment.
- Possesses the ability, to apply critical thinking skills, is organized and detail-oriented.
- Detail oriented and able to effectively prioritize work to increase cash and reduce accounts receivables.