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MediRevv Revenue Cycle Representative - Pre-Billing in Mission Hills, California

Title: Revenue Cycle Representative - Pre-Billing

Wage Category: Hourly, Non-Exempt

Reports to: Supervisor, Revenue Cycle Services

Location: Mission Hills, CA

Salary Range: Commensurate with experience

Job Summary:

The Revenue Cycle Representative works insurance accounts receivable to optimize cash flow and to meet organizational financial goals and objectives. Responsible for updating patient demographics and insurance information. Responsible for working payer correspondence, edits and aged account receivable and identifying and correcting billing errors. Responsible for resolving and/or appealing denials and rejections. Responsible for identifying billing issues and trends and reporting them to management.

Essential Functions:

An effective candidate will exemplify the MediRevv Mindset by helping the organization on a whole achieve balance between partners, people, and performance.

  • Review and mail all paper claims for Medi-Cal, PPO, EPO, Behavorial Health, Insured Services and Worker?s compensation. Prepare and mail secondary insurance claims.

  • Bill Vision claims through the website.

  • Correct all edits daily in the (TES) IDX Transaction Editing System and the PCS Fatal Edit Workfile. Identify and notify manager of trends in errors so that procedure notices and/or additional training to front-end staff can occur. Correct clearinghouse rejections and payer rejections daily. Notify manager regarding payer rejections trends.

  • Correct charge and claim discrepancies through the IDX Charge Correction function.

  • Resolve incoming payer correspondence within 48 hours of receipt.

  • Obtain pre-certifications and TARS as required by policy.

  • Obtain Medicare and Medi-Cal provider numbers. Prepare and send required provider re-credentialing information and additional credentialing information to these payers as requested. Research and monitor provider updates in GE/IDX.

  • Obtain, verify and update FFS patients? insurance information including co-payments and deductibles on new and existing patient accounts in GE/IDX on the IMS screen. Responsible for the accurate recording of the insurance information in GE/IDX.

  • Communicates payer address changes to management for GE/IDX system updates.

  • Record registration statistics daily. Complete monthly registration by the 5th working day of the month for review and distribution.

  • Responsible for the following-up on all unpaid invoices and initiating the tracking process by obtaining and recording the insurance claim numbers on the invoice. Must resolve any problems which delay claim payment and ensure that each invoice is paid in a timely manner.

  • Responsible for analyzing payer trends and reporting them to management.

  • Responsible for reviewing all account registration during the follow-up process for accuracy. Obtain and resolve registration information by contacting the patient. Update GE/IDX IMS screen as necessary.

  • Ability to resolve payer rejections and denials through the appeals process as required by each payer. Identify trends in rejections and payer contract issues. Communicate these trends to management.

  • Must demonstrate proficiency in evaluating insurance credit balances and prepare refunds for processing. Follow refund procedure as outlined

  • Actively participates with management to standardize work flows and improve our processes on an individual basis and through our process improvement meetings.

Minimum Position Qualifications:

  • Education: High School diploma/GED required

  • Experience: 1-2 year?s medical group practice or hospital billing experience required.

  • Understands third-party billing requirements including: Medicare, MediCal, PPO, EPO, HMO, Vision, Behavioral Health, Insured Services, Worker?s Compensation billing, HMO facility, and 2nd insurance billing.

  • Computer Skills: Proficient knowledge of Microsoft Office Suite (Word, Excel, etc.)

  • Epic experience is a plus!

Knowledge/Skills/Abilities:

A successful candidate must have proficient knowledge/capabilities in the following areas:

  • Extensive knowledge of insurances?PPO, EPO, HMO, Indemnity, Medicare, MediCal, Workers? Compensation.

  • Must possess excellent customer service and communication skills along

  • Ability to navigate Health Plan Websites to verify eligibility, benefits and claim status.

  • Must demonstrate proficiency in usage of all IDX modules pertaining to the revenue cycle registration, billing and collection procedures and Allscripts.

  • Must demonstrate a well-rounded knowledge of ICD-10 and CPT coding, CPC preferred.

  • Must demonstrate proficiency in the knowledge and usage of GE/IDX BAR which includes registration, enter charges, post receipts, invoice inquiry, patient inquiry, dictionaries that pertain to BAR, patient inquiry and TES.

Physical Requirements:

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard reach, stoop kneel to install computer equipment

  • Specific vision abilities required by this job include close vision requirements due to computer work

  • Light to moderate lifting is required

  • Regular, predictable attendance is required; including increased hours as business demands dictate.

The Real Deal

When you become a MediRevver great things happen. You can expect training, support, and a work family like no other. In return, we expect you to do great work and live our values. Everything we do is based on the right balance between partners, people and performance.

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