Revenue Cycle Specialist

Job Details

Job Location

2600 JOHNSTON ST - LAFAYETTE, LA

Position Type

Full Time

Job Category

Accounting

Description

Reports To: Revenue Cycle Manager

Job Description Summary

Revenue Cycle Specialist supports management and the mission of Hospice of Acadiana, Inc. (HOA) and Palliative Medicine of Acadiana, Inc. (PMOA) by supporting the admission process working with Payers to coordinate payment authorization periods, insurance verification, and submission of appropriate information. Works closely with Admissions, Clinical Teams, and Billing Office Staff.

Essential Job Functions/Responsibilities

• Verifies insurance coverage, benefit availability, coordination of benefits, exclusions, etc.
• Performs initial and concurrent reviews for authorization of services for all patients, when necessary.
• Responsible for the pre-authorization, certification, and re-certification processes.
• Completes and submits Notice of Elections.
• Serves as a liaison between Admissions, Clinical Team, Providers, and Billing Office to obtain all documentation needed for billing of claims.
• Initiates Payer contact within 24 business hours of notification of admission, depending on the Payer.
• Maintains electronic medical record of all conversations with Payer. Enters essential information into medical record according to proper format.
• Provides additional supporting documentation to Billing Office as needed.
• Notifies Billing Office and Clinical Teams of patient insurance policy changes or when primary coverage is exhausted.
• Sends letter regarding patient deductible and out-of-pocket expected costs, when applicable.
• Notifies Clinical Team and/or Provider Team when required information is missing and/or incorrect.
• Assists in the Corporate audit and other compliance audits.
• Cross-trains in other roles within the Financial department.
• Assists with other special projects as requested by Revenue Cycle Manager.
  
  

The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks or special projects, other than those stated in this description, by supervisors/Leadership Team.

Qualifications

• Education: High School Diploma or equivalent required. An Associate’s degree preferred.
• Experience: One to two (1-2) years’ related experience and/or training; or equivalent combination of education and experience, preferably in medical, home health, or hospice. Experience with managed care is preferred.