The Revenue Cycle Representative III (Rep III) is a multi-tasking advanced position that encompasses all key functions of the physician billing Revenue Cycle. The Rep III position requires an advanced revenue cycle knowledge that has been acquired through experience and developed through training and education. The Rep III supports patient-centered care and Customer Service by serving as a patient advocate during the life cycle of the account. The Rep III is expected to maintain productivity above the average standard identified by the Revenue Cycle Department. Quality and accuracy of work performed by the Rep III is expected to be consistently above 90% when audited. Rep III performance will be measured according to the Piedmont Healthcare values of Compassion, Commitment, Service, Excellence and Balance and expected to be tiered in the top 1/3 in the department.
Rep III Revenue Cycle duties may include but are not limited to Core Functions: Billing, Claims Filing, Data Entry, Charge Entry, Insurance Follow-Up, Self-Pay Follow-Up, Denial Management, Payment Posting, Refund Management, Credit Balance Management, Account Correction and Adjustment, Response to Patient Account Inquiries, Customer Service Advocacy, Self-Pay Collections, and Unapplied Cash, as well as, Advanced Functions; File Maintenance, System Support, Claims Edit Management, Claims Rejection Management, Front End Management, and Payment Variance Management.
The Rep III Employee will be proficient in one or more advanced Revenue Cycle responsibilities or functions. Advanced Revenue Cycle responsibilities and functions are those above and beyond that of Core
Revenue Cycle functions and are defined by the requirements outlined below:
? Highly specialized and skilled Revenue Cycle employees.
? Possesses advanced problem solving abilities.
? Supports all departments in the Revenue Cycle.
? Demonstrates advanced knowledge requiring little training in the core functions and responsibilities of the physician billing Revenue Cycle.
? Ability to analyze and assess Revenue Cycle reports, workflows, and processes.
? Assists and participates in creation of training manuals and job aids for their respective area(s) of expertise.
? Ability to function as a trainer.
? Ability to function as a lead.
? Ability to act as a resource to less experienced staff.
? Maybe asked to support quality assurance audits.
? Maybe assigned to special projects, tasks, or duties.
1. Advanced knowledge of third-party insurance in regards to plan types: HMO, PPO, POS, and Indemnity.
2. Excellent knowledge of the Medicare Program particularly as it relates to CPT and ICD9 coding CPT. Thorough knowledge of Medicare Fraud and Abuse regulations.
3. Ability to counsel patients financially regarding outstanding charges and effectively resolve problems via the highest customer service skills and etiquette.
4. Possesses advanced knowledge of the Practice Management System. Possesses the ability to run standard reports in order to answer questions from practice manager and physicians.
5. Possess thorough knowledge of HIPAA regulations.
6. This job requires proficiency with the computer systems that are used in the practice including Practice Management System, Internet products that relate to office functions and Microsoft office systems available to the office.
Core Revenue Cycle functions and duties include, but are not limited to:
? Complies with Revenue Cycle policies and procedures.
? Obtains demographic and insurance information.
? Works assigned task lists and/or work queues.
? Researches status of any third party payors through use of appropriate systems.
? Maintains up-to-date knowledge of third party payor reimbursements and managed care contracts.
? Maintains knowledge and is familiar with appropriate billing and accounts receivable systems.
? Identifies all components of an Explanation of Benefits/Explanation of Payments.
? Accurately counts and tracks all daily activities.
? Completes and accurately documents activity or communication on accounts.
? Meets department production standards consistently as defined by department management.
? Works special projects as assigned by Manager, Supervisor, or coordinator.
Customer Service Responsibilities:
? Communicates the organization’s financial policies to patients.
? Supports customer service calls.
? Performs collection follow-up support on assigned third-party accounts.
? Answers and resolves all incoming calls regarding patient accounts in a timely and professional manner.
? Works effectively and efficiently to minimize the number of abandoned calls.
? Identifies patients who require financial counseling intervention.
? Obtains necessary financial data to set up patient payment arrangements when necessary.
? Performs progressive collection steps to discuss and clear balances on multiple accounts.
? Coordinates classification for bad debt and charity.
? Works correspondence from insurance payers and patients on a daily basis. Refer items that need the attention of the practice to the practice.
? Assures call wait times meet expected business office standards and expectations.
? Contacts patients regarding their self-pay balances.
? Turns inbound calls into collection calls.
Payment Posting Responsibilities:
? Accurately posts payments and adjustments to the patient’s account.
? Applies denials to patient’s accounts accurately and timely.
? Applies payments and contractual adjustments to patient and company accounts following industry specific rules and guidelines.
? Ensures payment is received when expected; immediately pursues billing secondary insurance or billing the patient; applies appropriate allowance and adjustments.
? Balances payment batches to bank deposit.
? Balances entire patient account as needed.
? Balances batches effectively and completely daily.
? Enters all incoming daily receipts to the appropriate patient account.
? Maintains unapplied cash accounts for unidentifiable funds and researches and routes the fund appropriately.
? Receives, researches, and resolves insurance requested refunds.
? Identifies credit balance for potential refunds and provides them to the supervisor for review.
? Reviews and researches credit balance items accurately and timely for reports, check copies, and action sheets.
? Applies or refunds credit balance items as determined through research findings.
? Audits batch for accuracy.
? Indexes explanation of benefits to accounts in scanning system and/or billing system.
Patient Account Follow-up Responsibilities
? Verifies insurance as needed to resolve account balances.
? Reviews and works the entire patient account and not just a particular encounter.
? Bills third-party payors, when appropriate, by hard copy or electronic submission.
? Follows-up with third-party payers in order to facilitate claim payment.
? Assures the patient’s account is properly worked and information is updated in the system
? Appeals denials when claim is not paid according to the fee schedule.
? Re-files claims as necessary
? Takes adjustments and processes write-offs as necessary.
? Corrects claims and re-files as needed to ensure proper payment.
? Corrects line item balance discrepancies to merge debits and credits and create a balanced account.
? Identifies and reports billing errors and non-payment trends to management.
? Documents all telephone contacts and practice management system transactions and postings.
? Balances accounts through internal adjustments, contractual disallowances and refilling of claims.
? Researches and resolves all billing problems in a timely manner
? Turns in productivity on a daily basis.
? Performs other Revenue Cycle functions and duties as assigned by Revenue Cycle management.
KNOWLEDGE, SKILLS, ABILITIES
? Skill and ability to communicate effectively both verbally and in-writing.
? Skill and ability to handle multiple priorities and deadlines.
? Ability to work as a member of a team.
? Skill and ability in Microsoft Office applications.
COVID-19 Vaccine (Facility Guideline):