Primary City/State:

Phoenix, Arizona

Department Name:

Billing Reimbursement

Work Shift:

Day

Job Category:

Revenue Cycle

POSITION SUMMARY
This position identifies and evaluates quality and productivity for the Revenue Department.  Demonstrates understanding of denials, monitors complex adjustments and evaluates team members’ ability to meet satisfactory requirements of essential job functions.  Trains new employees to ensure compliance with all policies and standard operating procedures.  Responsible for working with management to develop learning materials and necessary tools for Revenue Specialist’s ongoing success.  Provides quality assurance and professional development to team members with continuing commitment to quality. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. 
 

CORE FUNCTIONS
1. Tracks, monitors, reports and provides feedback regarding quality and production performance to department supervisor, as well as to individual team members for educational purposes.

2. Reviews ongoing processes to increase knowledge of insurance billing, aging, denials requirements and changes. Proactively communicates escalated billing issues or trends to the billing management team based on audit results, and/or awareness of payor or process changes.  

3. Ensures that internal audits and quality controls are in place in accordance with departmental policies, procedures, generally accepted accounting practices and all applicable laws and regulations.  Updates and maintains memos, training manuals and Revenue Standard Operating Procedures as needed in Master Control.

4. Effectively communicates with employees verbally and in writing to address training or procedural questions.  Continuously reviews payor websites and incoming fax or mail communications for the purpose of identifying and communicating any pertinent updates to medical, contracting, and coding policy to fellow revenue staff that may potentially impact laboratory revenue cycle operations. 

5. Educates, trains and shares knowledge with team members of all changes and system updates.     Ensures training methods provided for both current and new staff members align with individual employee learning needs, and result in Revenue staff member being able to demonstrate the required competencies necessary in order to complete the essential job functions for the role. 

6. Processes, responds to, or posts correspondence, administrative requests, adjustments, transactions, and/or billing related requests as required and in a timely manner in accordance with departmental policies, procedures and performance goals. 

KNOWLEDGE/SKILLS/ABILITIES

Ability to clearly and efficiently communicate complex issues using strong verbal and written aptitude.Extensive knowledge of billing, insurance, computer systems, and medical billing processes.  Ability to prioritize and complete multiple tasks.Excellent communication skills, both written and verbal.Excellent organizational skills.Intermediate computer knowledge with various programs/software. Ability to work independently and accurately with high volumes of data and minimal supervision.Ability to effectively communicate with employees and/or other internal and external customers as needed.

MINIMUM QUALIFICATIONS

High School diploma or equivalent.Three (3) years’ of related experience in medical billing or in a healthcare setting. Comprehensive knowledge of ICD-10 coding, CPT coding, HCPCS coding, modifiers, and government and commercial payer guidelines. Excellent communication, comprehension, and organizational skills.Exceptional ability to provide constructive feedback to employees.

PREFERRED QUALIFICATIONS

Additional related education and/or experience.Extensive knowledge of clinical laboratory operations.Five (5) or more years’ of related medical billing/insurance experience. Extensive knowledge of ICD-10 coding as demonstrated by obtaining an American Academy of Professional Coders (AAPC) certificate, or by having successfully passed the Sonora Quest Laboratories ICD-10 certified coding examination.  

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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