Hospital Revenue Cycle Specialist Resume Example

• Process hospital claims electronically to insurance carriers; Work all billing errors including Medicare and Medicaid Government payers
• Submit electronic insurance rejects to resubmit with corrected insurance information
• Attach I-bills, ER records, implant invoices to paper billing when required
• Submit adjustment requests to Medicaid through online automated system
• Utilize monthly aged accounts receivable reports to follow up on claims
• Ensure all claims are submitted with a goal of zero errors and decrease bad debt write offs
• Follow up to correspondence from insurance carriers
• Credit or debit late charges through adjustment/voids or write off
• Research medical billing discrepancies for claims, appeals and denials
• Review insurance eligibility and prior authorization for commercial, Medicaid and Medicare insurance
• Maintain effective communication with all staff and management team
• Examine patients' insurance coverage, deductibles, co-pay, insurance carrier payment and remaining non covered balance
• Resolve accounts for underpayment/over payments to reconcile figures and review Remits/ EOB
• Maintain and resolve all issues and concern with staff and client

Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (emergency department visits, occupational therapy and speech therapy.
Correctly complete CMS 1500 for ASC services and UB04 for outpatient services, including modifiers.
Able to accurately abstract information from the medical records into the abstract system according to established guidelines.
Ensures codes are assigned in compliance with Federal, State and other coding guidelines.
Maintain 95% accuracy and productivity standards defined by department policy.
Keep abreast of coding guidelines and reimbursement reporting requirements.

• Perform day to day overall management of patient accounts and collection receivables
• Document all telephone and correspondent communications with third-party payors and guarantors Maintain weekly communication with Manager, staff and comply with department workflows and guidelines
• Prioritizes and work proactively on accounts in assigned work queue to ensure all accounts are submitted in a timely manner
• Maintain update knowledge of third party payor regulations of both state and federal guidelines
• Perform insurance follow up on unpaid accounts for payment and resolution
• Establish and maintain a high level of customer service approach working with all patients