Position Summary:

A Revenue Cycle Specialist is a medical billing expert who manages the financial lifecycle of a patient’s encounter with a healthcare organization. They are responsible for a variety of tasks that could include: Billing patients for care, reviewing insurance coverages and rules, handling payments/reviewing AR posting, claims proofing and submission, clarifying issues with insurance companies, denial management, and ensuring reimbursement for the facility on care provided. A Revenue Cycle Specialist will be responsible for working within the EMR efficiently and effectively, as well as identifying areas for improvement. This position will also be expected to help train and support other staff within all areas of the Revenue Cycle processes. A Revenue Cycle Specialist is well versed in all insurance payers rules, procedures, and practices in order to get the claims billed appropriately. This position will also be responsible for miscellaneous duties as assigned. 

Education/Experience:

Minimum of high school education

Billing/Coding Certification preferred

5+ Years of experience in healthcare billing and accounts receivable

Computer skills essential

Required Credentials (Licensure, Certification, or Registration):

None Required. 

Employment Variables:

Work is performed in an office environment. Work hours vary according to the workload and supervisory scheduling. Initial Tuberculosis (TB) test and drug screening is required by Winner Regional Health. Rubella titer will also be drawn upon hire and immunization is required if no past exposure or indication of immunization.  

Required to wear name tag provided by WRH and to dress in a professional manner.

Job Knowledge and Skills:

Tact and courtesy in dealing with all customers. Able to work with limited supervision. Must have knowledge of claim processing. Must be accessible to all departments for any questions regarding reimbursement. Good communication skills. Must be able to pay attention to detail. Must be able to understand all insurance updates. Must be able to concentrate on work tasks amidst distractions. Must exert self-control in difficult situations. Consistently projects a positive image of the facility.  

Direct Supervisor:

Director of Revenue Cycle

PART II: Code of Conduct

Honesty - We will do the right thing at all times, even if it is difficult, maintaining strong, ethical practices. We protect the confidentiality of others, including patients, staff and the facility as a whole. We will take responsibility for our actions.

Expertise - We will demonstrate superior judgment, training and skill, at all times, demonstrating professionalism while doing so. We will perform all aspects of our job to the best of our ability, utilizing all resources and tools available.

Approachability - We will be non-judgmental, friendly, and open and willing to listen to everyone we come into contact with while performing our duties. We are humble and learn from others.

Respect - We will be understanding and sensitive to others’ feelings; caring and responding in a manner that sets them at ease, keeping the situation in perspective without minimizing others’ feelings or reactions. We will listen to others with full attention in a sincere, civil fashion, being careful not to be judgmental of the speaker. We maintain composure when facing conflict and avoid jumping to conclusions and defaming another’s name.

Teamwork - We willingly work together with a common approach, trusting and supporting members of our organization, using our skills and resources, sharing information to achieve a common aim.

PART III: ESSENTIAL FUNCTIONS

Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job, along with the corresponding performance standards.

Function Explanation

Claims Processing Clerical Skills - Submits insurance claims in a timely manner and follows compliance with each payer’s billing procedures. Follows-up on denied or unpaid claims by running aged insurance lists. Makes adjustments to claims that are billed incorrectly and brings continuous errors to the attention of the Revenue Cycle Director.

People skills - Deals courteously with patients, outside organizations, and co-workers, both on the telephone and in person. Reacts calmly and effectively in conflict situations. Speaks clearly and concisely. Maintains confidentiality of sensitive information. Answers questions regarding patient accounts by phone or in person. Identifies and resolves patient billing complaints.

Research Skills - Uses resources available (i.e. Internet, Newslines, web conferences) to learn about new and updated billing or collection procedures. Participates in department meetings within the business office and attends other informative meetings as instructed by the office manager. Retains information for daily and future use.  

Organization and Communication Skills - Demonstrates critical thinking skills to manage day to day basic operations or has the ability to seek assistance when needed. Works steadily, efficiently, and shows consistent attention to the details of the work. Shares appropriate information and knowledge with coworkers.

Technology Implementation - Uses software system for daily operations. Documents all contacts regarding patient accounts in the computer software system. Attempts to learn new ways to utilize our computer software (i.e. different reports). Reduces paper printouts to prepare for paper-light billing.

Critical Thinking/Training - Assist in the training of staff to ensure all employees are aware of the rules for insurance billing and work together with all departments to establish better process and procedure with in Revenue Cycle functions.

PART IV: COMPLIANCE

Compliance - Must comply with the Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the position. The employee has a duty to report any suspected violations of the law or the standards of conduct to the Compliance Officer or the Chief Executive Officer.

PART V: PHYSICAL AND MENTAL REQUIREMENTS

General Activity - In a regular workday, employee may:

Sit 2-3 Hours at a time; up to 8-10 Hours during the day

Stand 1 Hours at a time; up to 0-2 Hours during the day

Walk .5 Hours at a time; up to 1 Hours during the day

Motion - Employee is required: (In terms of a regular workday, "Occasionally" equals 1% to 33%, "Frequently" 34% to 66%, "Continuously", greater than 67%.)

Bend/Stoop - Occasionally

Kneel, Duration 30 sec - Occasionally

Squat - Occasionally

Balance - Occasionally

Crawl, Distance - Occasionally

Twist - Occasionally

Climb, Height - Occasionally

Keyboarding/Mousing - Frequently

Reach above shoulder level - Occasionally

Physical Demand - Employee’s job requires he/she carry and lift loads from the floor, from 12 inches from the floor, to shoulder height and overhead. Employee’s job requires a pushing/pulling force to move a load (not the weight of the load).

Physical Demand Classification: Carrying/lifting weight and pushing/pulling force:

• Sedentary
• Occasionally 10 lbs. 
• Frequently Negligible
• Constantly Negligible

Sensory Requirements:

•  Yes/No Explanation (if Yes)

Speech Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. 

Yes

Ability to exchange information with others on the phone. Extensive interactions with customers, co-workers and supervisors either in person or via telephone.

Vision (VDT) Are there specific vision requirements for the job?

Yes

Must be able to edit and proof work and to discern small print and a variety of handwriting. Must be able to operate office equipment.

Hearing Ability to receive detailed information through oral communications, and to make fine discriminations in sound; i.e., making fine adjustments on machine parts, using a telephone. 

Yes

Vital for communications with other staff directly or via telephone.

Environmental Factors

• Yes/No Explanation (if Yes)

Working on unprotected heights No

Being around moving machinery No

Exposure to marked changes in temperature and humidity No

Driving automotive equipment No 

Wearing personal protective equipment No

Exposure to atmospheric conditions (i.e. fumes, dust, odors, mists, gases, or poor ventilation) No

Exposure to extreme noise or vibration No

Exposure to blood, body fluids and waste No

Exposure to radiation No

Exposure to other hazards (i.e. mechanical, electrical, burns, or explosives) No

Emotional/Psychological Factors

• Yes/No Explanation (if Yes)

Stress: Exposed to stressful situations

Yes

On occasion when information is needed and not available. Working with a variety of co-workers at one time. High accountability. Must be able to establish priorities. Works in an environment of frequent interruptions. May be monitored for productivity and quality.

Concentration: Must be able to concentrate on work tasks amidst distractions.

Yes

Work must be done accurately. Constant interruptions in a multi-task clerical environment.

Must exert self-control. 

Yes

Must be able to display control and confidence under stress or amidst distractions.

PART VI: JOB RELATIONSHIPS

Supervises No supervisory responsibilities

Supervisory responsibility

# Direct Reports:       

# Indirect Reports:       

Age of Patient Populations Served 0 Neonates: 1-30 days

Infant: 30 days - 1 yr

Children: 1- 12 yrs 

Adolescents: 13- 18 yrs

Adults: 19- 70 yrs

Geriatrics: 70+ yrs

All

Not applicable

Internal Contacts 1 Patients

Providers: (i.e. Physicians, Therapists, Social Workers)

Staff: (i.e. clinical and administrative support staff)

Volunteers

Others:       

External Contacts 1 Patients

Families/Significant Others

Providers

Vendors

Community and Health Agencies

Regulatory agencies

Other: Job Applicants