Revenue Cycle Specialist II

Gulfside Healthcare Services, Inc.

Land O' Lakes, FL, USA

Published: 6/14/2022

Full Time

Job Description

Reporting to the Revenue Cycle Supervisor, the Revenue Cycle Specialist II is responsible for the accurate, timely completion and submission of claims to multiple third-party payers, including but not limited to Medicaid (including Florida Medicaid and Medicaid Managed Care), as well as self-pay. The position supports billing, collections, and accounts receivable functions for hospice services and collaborates with internal teams and external partners to ensure compliant reimbursement and timely resolution of claims.

This is an on-site position.

EDUCATION AND QUALIFICATIONS:

High school diploma/GED required. Associates preferred.
Two-to-four years’ experience in health care billing and collections.
Billing information systems knowledge preferred.
Working knowledge of home health, hospice and physician billing preferred.
Knowledge of Microsoft Excel preferred.
Knowledge of governmental regulations and billing guidelines preferred.
Preferred: Working knowledge of Florida Medicaid billing, including hospice and Medicaid managed care requirements.
Preferred: Exposure to Skilled Nursing Facility (SNF) billing processes or hospice room and board coordination.
Preferred: Experience interacting with external payers or community-based providers to resolve billing issues.

ESSENTIAL JOB RESPONSIBILITIES:

Ensures reimbursement through efficient, accurate and timely billing process for effective accounts receivable management.
Work pre-billing report for assigned payers in preparation for month end close.
Generates claims for submission to payers in accordance with established schedule.
Utilizes technology to manage clearinghouse and payor accept/reject submissions and reports timely.
Responsible for accurate posting of cash payments and preparation of cash balancing process.
Review A/R reports and research unpaid claims. Takes necessary steps to collect unpaid claims and address credit balances. Provide reports to the Patients Account Manager as needed.
Process correspondence and telephone calls from all payors regarding claims.
Complete appeals on underpaid claims to the payer.
Applies knowledge of Florida Medicaid and payer-specific requirements to identify claim issues, resolve denials, and reduce reimbursement delays.
Communicates with external partners, including skilled nursing facilities and payer representatives, to obtain documentation or clarification needed to support billing and payment resolution.
Identify, prepare, and submit patient account adjustments to Revenue Cycle Manager and post in electronic health record (EHR) once approved.
Assist as needed with payer authorizations and verification as required and completed documentation in electronic health record (EHR).
Protects the confidentiality of patient and organization information through effective controls and supervision of billing operations.
The incumbents may be requested to perform job-related tasks other than those stated in this description.

NOTE: All Gulfside Healthcare Services positions (except some Thrift Shoppe Positions) require an AHCA Level 2 Fingerprint screening for eligibility through the AHCA Florida Care Provider Background Screening Clearinghouse. Please refer to this link for more information on this: https://info.flclearinghouse.com