Job Summary:

The Revenue Cycle Specialist is responsible for evaluating payments posted for contracted plans compared to published fee schedules with a focus on underpayments and overpayments. Must be proficient in manual and tape payment posting including denials and adjusting transactions. Major focus on preparing payer project spreadsheets regarding denied claims, submitting and tracking projects with insurance representatives through to resolution.

Job Requirements:

• Run underpayment, denial, overpayment reports to analyze payment from managed care payers; also run non-par contract reports.
• Confirm contracts are loaded correctly, recommend changes and follow up to ensure accuracy.
• Review underpayments and overpayments, prepare spreadsheet and summarize findings; escalate as appropriate.
• Schedule and attend departmental meetings/conference calls.
• Prepare and submit denied claims targeted project files to payers; track reprocessing of project files.
• Provide feedback to both department and payers on project status.
• Maintain tracking sheet of pending/resolved issues and historical payer issues.
• Monitor payer project work queues for both pending and submitted claims; move claims between work queues while documenting.
• Identify problematic claim trends and contract violations.
• Investigate receipt of payment and payer portals.
• Post contractual allowances based on fee schedule or expected payment/denial amounts per third party contracts.
• Contact insurers regarding recoupment payments, double debits, overpaid accounts and missing checks; initiate dispute process as needed.
• Update insurance information in the system as necessary, initiate and support secondary and tertiary billing.
• Perform other duties as assigned.

Job Qualifications:

• High school graduate or equivalency required.
• A minimum of 5 years' relevant experience required, including comprehensive knowledge of cash application and posting, third party payer guidelines and reimbursement practices, and managed care contracts.
• Demonstrated proficiency preparing and presenting Excel spreadsheets required.
• Strong proficiency in computer skills including, but not limited to, Electronic Health Systems, Microsoft Excel, Microsoft Word, email systems, etc.
• Knowledge of ICD-9 and CPT-4 coding and medical terminology preferred.

Hourly Rate Ranges: $21.63 - $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 61^st 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. Please be advised that the corporation requires COVID-19 vaccinations for all employees unless an exemption request for a disability / medical or religious accommodation has been approved.