JOB SUMMARY:
- The Certified Revenue Cycle Representative is a vital member of the hospital's Business Office/Patient Financial Services team, responsible for managing patient accounts, ensuring accurate and timely billing, and effectively following up on outstanding balances. This role requires a strong understanding of healthcare billing processes, insurance regulations, and excellent communication and problem-solving skills. The representative serves as a key point of contact for patients regarding their financial obligations and works collaboratively with internal departments and insurance payers to optimize the revenue cycle. The ideal candidate will be a certified professional with a commitment to accuracy, compliance, and providing exceptional customer service.
PRIMARY JOB DUTIES:
- Adheres to Brodstone Healthcare’s Mission, Vision and Values.
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Adheres to Brodstone Healthcare Standards of Behavior.
- Review and analyze patient accounts to ensure accuracy and completeness of billing information.
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Investigate and resolve billing discrepancies, errors, and denials.
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Follow up on outstanding accounts receivable (A/R) through various methods (e.g., phone calls, correspondence, system worklists).
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Document all collection efforts and account activity accurately and thoroughly in the patient accounting system.
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Process patient refunds and adjustments in accordance with hospital policies and procedures.
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Collaborate with other departments (e.g., Patient Access, Health Information Management, Clinical Departments) to obtain necessary information for accurate billing and collection.
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Verify insurance eligibility and coverage for patients.
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Submit electronic and paper claims to insurance payers accurately and timely.
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Monitor claim status and follow up on unpaid or denied claims with insurance companies.
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Analyze Explanation of Benefits (EOBs) and remittance advices to identify payment discrepancies and take appropriate action.
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Initiate and manage the appeals process for denied claims, ensuring all required documentation is submitted.
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Stay updated on payer rules, regulations, and coding guidelines.
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Respond to patient inquiries regarding billing statements, insurance coverage, and payment options in a professional and courteous manner.
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Explain billing procedures, charges, and payment policies to patients.
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Assist patients with setting up payment plans and exploring financial assistance options.
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Resolve patient complaints and concerns related to billing issues, escalating complex issues as needed.
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Maintain patient confidentiality in accordance with HIPAA regulations.
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Adhere to all federal, state, and local regulations related to healthcare billing and collections.
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Comply with hospital policies and procedures related to the revenue cycle.
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Maintain knowledge of current coding (CPT, HCPCS, ICD-10) and billing guidelines.
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Participate in training and educational programs to enhance job knowledge and skills.
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Identify and report potential compliance issues or areas for improvement in the revenue cycle process.
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Utilize the hospital's patient accounting system and other relevant software applications effectively.
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Generate and analyze basic reports related to assigned tasks and account status.
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Maintain accurate and organized records.
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Certification in a relevant revenue cycle field (e.g., CRCR, HBMA).
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Strong understanding of healthcare billing processes, insurance regulations, and coding principles.
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Excellent communication, interpersonal, and customer service skills.
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Proficient in using patient accounting systems and other relevant software.
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Strong analytical and problem-solving skills.
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Ability to work independently and as part of a team.
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Attention to detail and accuracy.
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Ability to maintain confidentiality Perform other duties related to the efficient operation of the business office as directed by management.
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Performs other duties as assigned
EDUCATION:
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Required
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GED or High School Diploma Required
EXPERIENCE:
CERTIFICATE, LICENSE, REGISTRATIONS:
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Required
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Certified Revenue Cycle Representative (CRCR) within 12 months of employment.
Join Brodstone Healthcare and have a lasting impact on Rural Nebraska!
