Revenue Cycle Specialist II Hybrid/Remote Onsite

The Revenue Cycle Specialist II will be responsible for the review, minor analysis, trending and follow up of Third Party Claims Reimbursements to include the identification, billing and collection of payments. The Revenue Cycle Specialist II will actively engage with other departments to ensure timely resolution of all outstanding accounts to ensure maximum reimbursement.

1. Apply advanced knowledge of payer contracts, payment polices, and regulations to ensure correct payment of claims


2. Demonstrate thorough knowledge of complex insurance correspondences to include explanation of benefits, remittance advices and denial letters.


3. Verify insurance benefits, understanding insurance payments, denials and correspondences through Advanced understanding and ability to navigate payer websites and vendor applicable systems


4. Maintain established quality assurance and productivity benchmarks while utilizing best practice standards established.


5. Process all referrals in timeframe established by department


6. Accurately update account in all systems to reflect work being preformed


7. Apply logic and critical thinking to identify payer trends resulting in payment delays


8. Communicate identified payment trends to leadership promptly and accurately and provide solutions to resolve challenges and issues.


9. Assist with training and mentoring of new hires


10. Ensure compliance with state and federal laws regarding all aspects of role.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities.