Job Opportunities API

Description Revenue Cycle Specialist (Medicare) Location: Nashville, TN/ Remote Status: Full Time Days: Monday - Friday Hours : 40/week Are you a Revenue Cycle/professional who desires to work in a capacity in which your efforts directly impact clinicians, patients and their families? If you are excited to use your talents and skill set in a way that truly makes a difference in the middle Tennessee healthcare market, we can't wait to talk with you! SUMMARY Primarily responsible for generating billing cycles posting payments and follow-up on claims to ensure timely payment. ESSENTIAL DUTIES AND RESPONSIBILITIES • Generates patient claims through EMR billing system. Upload EMC file to clearinghouse as soon after target bill date and errors/holds are clear. Continue review of unsubmitted claims to avoid timely filing errors. • Manage and hold claims waiting compliance review completion. Work with Revenue Cycle team to ensure billing compliance. • Review, key or follow up on 81A (NOE) prior to submission of initial claim. (if applicable to assigned duties) • Review, key or follow up on 815's, 817's and 818's when necessary. • Review and corrects RTP's in the DDE system on a regular basis. • Post Medicare PIP remittance advices through Clearinghouse auto post or manually when necessary. • Follows up regularly on unpaid claims by using DDE or phone call to PBGA service center for assistance or unresolved claim issues. Document response and any follow-up actions taken in EMR. • Work with the Dept. Director on Medicare credit balances to ensure compliance. • Work with other Hospice agencies to ensure smooth transitions between benefit periods and sequential billing. • Notifies the Dept. Director of any problems with claims or processes. • Assists other Revenue Cycle Specialist as needed to meet department goals. • Submit write off requests with documentation after all collection efforts have been exhausted to the Dept. Director. • Run admission report, assign and enter appropriate ICD-10 codes into EMR based on physician CTI. (if applicable to assigned duties) • Using pre-bill CPT audit sample to complete compliance review through physician coding compliance software. Report findings to appropriate Directors and CMO. (if applicable to assigned duties) • Report individual finds to the physician for review and resolution of the coding discrepancy. After physician review/approval make coding changes and note in EMR. Report to billing staff when claim can be released. (if applicable to assigned duties) • Other duties may also be assigned. Requirements EDUCATION and/or EXPERIENCE High School diploma required. One year college or technical school: one to three years related experience or equivalent combination of education and experience. CERTIFICATES, LICENSES, REGISTRATIONS If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law.