Revenue Cycle Specialist (1950)

US Heart and Vascular is in need of a Revenue Cycle Specialist to join our team at Samuel Family Cardiology in Spring, TX

Responsibilities:

• Responsible for billing all patient claims in a timely manner
• Perform extensive claims follow up activities, utilizing the current Practice management (PM), and clearinghouse systems.
• Investigate, analyze, and resolve problematic and delinquent insurance claims.
• Work daily claims rejection lists including but not limited to, eligibility, coordination of benefits, clearinghouse smart edits, etc.
• Responsible for appeals management – 1st, 2nd and ADJ level appeals as well as peer-to-peer reviews.
• Utilize clinical applications, payer websites and other systems as a research tool to retrieve medical documentation, patient eligibility information, billing guidelines, patient referrals, and hospital or procedure code authorizations to substantiate corrected claims submissions, through written appeals, and coding reviews, etc.
• Establish and maintain effective working relationships with carrier representatives and internal and external clients.
• Collaborate with physicians and billing team to resolve coding and billing discrepancies
• Remain abreast of carrier/payer updates as it relates to Billing and Collections guidelines including claim submissions, claim appeals, grievance procedures and policy changes.

Requirements:

• Proficient in medical terminology, anatomy, and physiology
• Strong knowledge of ICD-10 coding
• Familiarity with medical office procedures and billing practices
• Flexible, Detail Oriented, Customer focus, Team working, Initiative, Problem solving, Organized, Self-motivated
• Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws.
• Computer skills – good working knowledge of MS office Ability to communicate effectively with others, both verbally and in writing
• Proven ability to manage time, meet deadlines and prioritize
• High School Diploma or equivalent required
• Knowledge of the accounts receivables (A/R) process
• Bachelor's Degree in a related field preferred
• At least four (4) years’ healthcare or insurance billing processing experience required
• Knowledge of medical terminology, CPT, ICD-10-CM, HCPC codes, CCI edits and HIPAA regulations
• eClinicalWorks experience a plus

About Spring, TX:

Spring TX offers the perfect blend of suburban comfort and city convenience. With beautiful tree-lined neighborhoods, excellent schools, and easy access to Houston’s major employers and attractions, it’s an ideal place for families and professionals alike. Residents enjoy plenty of local charm, from The Woodlands’ shopping and dining to scenic parks, trails, and community events that bring people together. Spring delivers a warm, welcoming atmosphere with all the perks of Texas living.