Revenue Cycle Management Administrator

POSITON TITLE: Revenue Cycle Management Administrator NonExempt Position

RESPONSIBLE TO: Revenue Cycle Manager

MAJOR DUTIES: The RCM Administrator position works under the supervision of the RCM Manager. The incumbent is tasked with working the front end of the revenue cycle required State Reporting EBT food benefit cycle administration and other tasks assigned.

Tasks include reviewing insurance and funding eligibility patient census service and claim data reviews by researching failed activities and claims then communicating with department leaders the errors to be resolved prior to billing out services.

Monthly or quarterly prepare spreadsheets to pull reports and review data to go into the spreadsheets and complete missing data then run macros to format data into acceptable formats. Continuously track authorizations and state reporting transactions in a spreadsheet to then pull an EHR EDI file edit the file for accuracy and upload the file to an SFTP site and pull the EDI acceptance report and review it for errors. Correct the errors to resend in a new EDI file. Review the census daily for newly admitted and newly discharged patients. Request new EBT cards withdrawal funds calculate refunds completes change of circumstances and completes month end EBT required duties.

The incumbent is responsible for accuracy efficiency and retrieval of processed data. The position includes proofing material entered and generating data reports as required. The incumbent performs the following additional duties:

• Three days in advance of scheduled services confirms and updates patient and insurance information by checking third party sources and by contacting the patients and insurance companies. Set up and maintain eligibility batches and review reports monthly for eligibility changes.
• Calling the local EBT food benefits office to request alternate EBT cards for patients which includes driving to the local EBT food benefits office to pick up the new cards. Manages the cards calculates the funds to be collected and travels to an agency location to run the cards through the EBT device for calculated funds; determines when to return funds. Month end duties require travel into an agency location to close out discharged patient cards. Manages data related to EBT processes and works closely with the local government officials who oversee the EBT program.
• For the claim review process the incumbent must accurately review claims for any coding or fee errors. Incumbent must be confident in communicating via email Microsoft Teams or phone with other departments to resolve errors and then follow up to ensure the errors are resolved by the deadline.
• Using claim reports create invoices to be forwarded to accounting and Clark County.
• Data enters service activities into Carelogic EHR for bus passes.

• Works closely with clinical staff to enroll patients with NS ASO funding.
• Enters data into state data repositories for specific populations.
• Complete training and attend weekly staff/other meetings.
• Maintains strict confidentiality; adheres to all 42 CFR part 2 and HIPAA guidelines/regulations.
• Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation.
• Maintains current knowledge of internal industry and government regulations as applicable to assigned function.
• Works as part of the agencys revenue cycle management team and assists when needed.
• Supports and implements agency policies and procedures.
• Performs special projects related to data entry reporting and billing as assigned by supervisor.

KNOWLEDGE AND SKILLS REQUIRED BY THE POSITION

• High School diploma or equivalent.
• Minimum of two years experience in clerical data entry or billing role preferably in a medical environment.
• Experience with insurance billing Medicaid billing use of ProviderOne and/or knowledge of behavioral health services strongly preferred.
• Prior experience with Qualifacts CareLogic electronic health record preferred.
• Able to problem solve issues and apply them to daily problems that occur.
• Able to perform job duties effectively while working independently.
• Advanced knowledge in Excel to produce accurate information and reports using Microsoft Excel.
• Ability to communicate clearly and fluently.
• Great attendance.

• Ability to work well with others.
• Must be highly organized VERY detail oriented able to multitask in a changing environment.

GUIDELINES

Requires that the incumbent relies on specialized training and/or equivalent experience and performs duties in accordance with Washington Administrative Codes Federal regulations governing the confidentiality of patient files and Lifeline Connections Policy and Procedure Manual.

PERSONAL CONTACTS

Contacts are with the members all agency departments and programs consumers significant others of the consumers and representatives of various community agencies specializing in the treatment of chemical abuse and mental illness. All personal contacts are carried out in accordance with federal and state laws dealing with the confidentiality of patient records.

PHYSICAL DEMANDS

While performing the essential functions of the job the employee is regularly required to sit speak clearly hear and use hands and fingers to manipulate writing utensils and keys on a keyboard.

WORKING ENVIRONMENT

Working hours are spent indoors in offices or other meeting rooms. Participation in staff retreats and staff development activities will be required.

IMMEDIATE SUPERVISOR: Revenue Cycle Manager