Revenue Cycle Management
Patient Scheduling
- Scheduling office and hospital based medical procedures
- Scheduling office and hospital based medical procedures, tests and imaging ensuring available time is utilized to maximum efficiency.
- Interface with appropriate hospital staff to ensure a cohesive working relationship in providing patient care
- Entering notes/special instructions in the EMR (Electronic medical Record)
- Scheduling office and hospital based medical procedures
- Perform all duties within HIPAA regulations
Insurance Verification
- Verify insurance eligibility, deductible, copay, coinsurance, and restrictions
- Explain coverage details to insurance representatives or customers when necessary
- Document the coverage in the EMR (Electronic medical Record)
- Meet deadlines for verifying insurance benefits
- Calculate client’s out of pocket cost if they use their insurance coverage
- Perform all duties within HIPAA regulations
Claims Submission
- Resolves medical claims by approving or denying documentation
- Ensures legal compliance by following company policies, procedures guidelines
- Maintains quality customer services by following customer service practices
- Protects operations by keeping claims information confidential
- Prepares reports by collecting, analyzing, and summarizing information
- Perform all duties within HIPAA regulations
Denial Management
- Investigate denied third party claims and take actions to overturn denials for payment
- Communicate global payor issues with the billing team
- Ensure all denials are fully worked
- Able to build and maintain relationships with payer representatives in coordination with RCM and Contracting teams
- Perform all duties within HIPAA regulations
Account Receivables
(Follow-up and Appeals)
- Contacts government or commercial healthcare insurance companies to follow up on outstanding AR’s
- Identifies billing errors for correction and resubmission
- Follows up on payment errors, low reimbursement and denials
- Reviews insurance EOB’s and initiates appeals as necessary
- Prints and mails UB04s or HCFA 1500s as necessary for account resolution
- Remains up to date with all commercial and managed care pricing models, rules and regulations
- Remains up to date with all Medicare and Medicaid rules and regulations
- Perform all duties within HIPAA regulations
Billing and Collections
- Coordinate activities to include the processing of third-party claims and the maintenance, review, updating and collection of accounts
- Reviews and approves various transactions related to the collection process
- Investigates special collection problems and confer with designated point of contact as required
- Answer inquiries from insurance companies concerning outstanding accounts
- Assists in the preparation of reports and analyses, setting forth progress and adverse trends
- Perform all duties within HIPAA regulations
Payment posting
- Completes payment entry in a timely and accurate manner
- Posts payments to practice management system
- Records batch totals with date and initials on payment receipt spreadsheet
- Balances batches and runs transaction reports
- Verifies all EFT deposits and scanned checks have been posted by month end
- Properly communicates and documents payment denials in the practice management system
- Perform all duties within HIPAA regulations
