The Revenue Cycle Coordinator assures the daily oversight of the contracted Revenue Cycle Management services for a client in Maryland. Responsibilities of coordination include payor enrollment activities; insurance verification and precertification activities; prepayments for products and services; coding; claim submission and denials management; accounts receivable follow up; payment posting; patient billing cycle and collections efforts; and financial counseling. The coordinator assures an effective and efficient revenue cycle for all products and services rendered.
This is a unique position where the candidate is employed by Advantum Health but is located within the office of the client. The overall goal for this position is to collaborate with Advantum and the client team members to provide support to both parties.
- Supports Advantum Health’s vision, mission and values and follows all policies and procedures of both the employer and the Client.
- Maintains confidentiality for all information, including Protected Health Information (PHI), accessible while performing job duties.
- Maintains compliance with OSHA, HIPAA, IT Policy, patient safety standards and all other Advantum/the client requirements.
- Collaborates with team members from Advantum Provider Enrollment and the client ensuring the completion of related enrollment activities for all the client providers and facilities are completed; including CAQH; NPPES; Medicare; Medicaid and Commercial insurance carriers and configures billing software applications of such activity.
- Performs system maintenance for all electronic remittance advices and electronic funds transfer setup with all contracted insurance carriers.
- Maintains the client billing fee schedule based on 300% of the current Medicare fee schedule and coordinates all procedure and diagnosis changes with operations for standardized electronic health record and billing procedures.
- Maintains current insurance carrier allowable schedules within the billing software systems to assure accurate and appropriate claim adjudication and payment.
- Controls, monitors; reconciles, and reports all charge entry lag activity for all the client products and services.
- Coordinates biannual evaluation and management claim and documentation audits for all the client, Providers, collaborating with Advantum to resolve all concerns.
- Communicates all insurance carrier billing protocols and maintains all incoming correspondence from contracted insurance carriers.
- Coordinates the posting of payments by all insurance carriers within the billing software system, following up with the needed team members to get all payments posted prior to month end.
- Coordinates all claims denials management activity including provider documentation addendums; appeals; reconsideration requests; and trend reporting.
- Manages insurance-based accounts receivables within preestablished goals.
- Coordinates all aspects of the refund workflow process for all credit balances as well as insurance refund requests/takebacks,
- Creates and maintains all revenue cycle operations policies and procedures as well as standard operating procedures.
- Coordinates patient insurance verification and precertification/authorization activities for all the cleint products and services.
- Coordinates estimated patient financial responsibility obligations and assures appropriate prepayments are made prior to those services being rendered where appropriate.
- Maintains patient related accounts receivable based on predefined goals.
- Responsible for the administration of the patient billing cycle including patient statements and soft collections attempts for patients at risk for collection agency activity.
- Development and maintenance of a patient collections program.
- Administration of the Maryland Trauma Fund.
- Development and maintenance of the patient financial hardship program.
- Creation and administration of patient payment programs.
- Coordinate’s workflow processes for all patient related payment posting.
- Oversees patient call center for patient related billing inquiries.
- Works with Finance for all time-of-service payment reconciliation.
- All other duties as assigned by the client in collaboration with Advantum management
- Possesses thorough knowledge of accounts receivable, insurance payment policies, and insurance requirements/procedures.
- Demonstrates attention to detail with the ability to problem solve.
- Possesses aptitude to think and work independently.
- Performs mathematical functions proficiently.
- Demonstrates strong communication skills to interact with patients, the client staff, and management.
- Utilizes excellent customer service skills.
- Demonstrates computer proficiency with regards to data entry and basic PC use
- Minimum of five (5) years of medical revenue cycle leadership experience.
- Certification in Coding preferred but training in basic coding required.
- Undergraduate Degree in related field required.