Job Summary:

The Revenue Cycle Specialist III is responsible for verifying patients’ insurance and eligibility, acquiring pre-determination of benefits, precertification, and authorizations for all surgical cases and procedures within the Division of Cardiology. In addition, the incumbent will responsible for complete oversight of cases following completion of performed procedures, as well as obtaining all required documentation to secure physician payment. This role will involve all responsibilities related to the Electrophysiology and Nuclear PET divisions of Cardiology.

Job Responsibilities:

• Receive cases via Epic Work queue, DAR (Department Appointment Report), and Cath Case Log/Master Daily Schedule (where applicable).
• Review insurance and registration information to ensure recent and valid RTE (real time eligibility) is up to date. Update registration and insurance accordingly.
• Work with centralized Cardiology estimate team for non-participating or self-pay cases to ensure valid estimate is created and submitted to patient prior to procedure. Provide financial counseling with estimates.
• Call/submit online or phone request to insurance carrier to initiate authorization process. Includes obtaining pre-determination of benefits for procedure(s) and following obtains pre-certifications and authorizations for procedures ensuring all CPT codes are authorized that apply to scheduled procedure, as well as adding common codes anticipated to be “add on” procedures within the scope to authorization (when/where applicable by payer).
• Fax all necessary clinical documentation to clinical staff as needed for each procedure.
• Create electronic Epic Authorization in the system, document information received by insurance/online request to include pre-auth #, representative name, etc., information faxed, and link the auth to the scheduled procedure.
• Call patient’s PCP to obtain referral according to insurance plan, as well as other medical reports pertinent to procedure. Add referral info to Epic authorization.
• Follow up with referring physician's office or lab to ensure pre-op testing was completed and results were faxed and received. Document in Epic.
• Run Cath Case Log/Master Schedule to review cases against original schedule and Encapture MD system.
• Update Epic electronic authorization and document system. Confer with hospital FCC where applicable.
• Other duties as required.

Job Qualifications:

• High school graduate or GED certificate is required.
• CPC certification required.
• A minimum of 2 years’ experience in a physician billing or third party payer environment where diagnostic and interventional procedures are part of the practice.
• Knowledge of medical terminology, CPT & ICD-10 coding experience is required.
• Candidate must demonstrate the ability to understand and navigate contracts, insurance benefits, exclusions, and other billing requirements as well as claim forms, HMOs, PPOs, Managed Care, Medicare, Medicaid and compliance program regulations.
• Candidate must demonstrate strong customer service and patient-focused orientation and the ability to understand and communicate insurance benefits explanations, exclusions, denials, and the payer adjudication process.
• Must demonstrate effective communication skills both verbally and written.
• Intermediate proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
• Experience in Epic and or other electronic billing systems is preferred.
• Previous experience in Cardiology is preferred.

Hourly Rate Ranges: $27.40 - $36.06

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

61st Street Service Corporation

At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.