Certified Revenue Cycle Representative
Certified Revenue Cycle Representative
Posted on :
07-04-2025
Employer Active
1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
07-04-2025
Job Description
JOB SUMMARY: The Certified Revenue Cycle Representative is a vital member of the hospitals 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 problemsolving 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 representative with a commitment to accuracy compliance and providing exceptional customer service.
EDUCATION:
GED or High School Diploma (Required)
CERTIFICATE LICENSES REGISTRATIONS:
Certified Revenue Cycle Representative (Required)
PRIMARY JOB DUTIES:
- Adheres to Brodstone Healthcares Mission Vision and Values.
- Adheres to Brodstone Healthcare Standards of Behavior.
- Review and analyze patient accounts to ensure accuracy and completeness of billing information.
- Investigate and resolve billing discrepancies errors and denials.
- Follow up on outstanding accounts receivable (A/R) through various methods (e.g. phone calls correspondence system worklists).
- Document all collection efforts and account activity accurately and thoroughly in the patient accounting system.
- Process patient refunds and adjustments in accordance with hospital policies and procedures.
- Collaborate with other departments (e.g. Patient Access Health Information Management Clinical Departments) to obtain necessary information for accurate billing and collection.
- Verify insurance eligibility and coverage for patients.
- Submit electronic and paper claims to insurance payers accurately and timely.
- Monitor claim status and follow up on unpaid or denied claims with insurance companies.
- Analyze Explanation of Benefits (EOBs) and remittance advices to identify payment discrepancies and take appropriate action.
- Initiate and manage the appeals process for denied claims ensuring all required documentation is submitted.
- Stay updated on payer rules regulations and coding guidelines.
- Respond to patient inquiries regarding billing statements insurance coverage and payment options in a professional and courteous manner.
- Explain billing procedures charges and payment policies to patients.
- Assist patients with setting up payment plans and exploring financial assistance options.
- Resolve patient complaints and concerns related to billing issues escalating complex issues as needed.
- Maintain patient confidentiality in accordance with HIPAA regulations.
- Adhere to all federal state and local regulations related to healthcare billing and collections.
- Comply with hospital policies and procedures related to the revenue cycle.
- Maintain knowledge of current coding (CPT HCPCS ICD10 and billing guidelines.
- Participate in training and educational programs to enhance job knowledge and skills.
- Identify and report potential compliance issues or areas for improvement in the revenue cycle process.
- Utilize the hospitals patient accounting system and other relevant software applications effectively.
- Generate and analyze basic reports related to assigned tasks and account status.
- Maintain accurate and organized records.
- Certification in a relevant revenue cycle field (e.g. CRCR HBMA).
- Strong understanding of healthcare billing processes insurance regulations and coding principles.
- Excellent communication interpersonal and customer service skills.
- Proficient in using patient accounting systems and other relevant software.
- Strong analytical and problemsolving skills.
- Ability to work independently and as part of a team.
- Attention to detail and accuracy.
- Ability to maintain confidentiality Perform other duties related to the efficient operation of the business office as directed by management.
- Performs other duties as assigned.
Required Experience:
Unclear Seniority
Employment Type
Full Time
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