RCM - Billing Specialist

Summary

The primary purpose of this position is to manage the billing process and liaison by communicating and resolving root cause analysis (RCA) between Flight Coordination and follow-up to ensure maximum reimbursement to MHP. Acts as a focal point within the company for all revenue cycle activities, Quality Assurance, and Billing.

Relationships

Interfaces To: All employees, vendors and customers

Essential Duties & Responsibilities

• Develops reoccurring reimbursement/revenue cycle reports for revenue cycle. Troubleshoots Salesforce Workbench reports and trains staff on how to effectively report. Reports include target vs. actual collection rates and actual vs. target A/R days.
• Analyzes workflow and operational procedures to identify opportunities for improved reimbursement, develops and implements policies and procedures to ensure all services are captured, recorded, processed and billed in an accurate and timely manner.
• Analyzes monthly A/R reports by payor and monitors overall department performance. Recommends corrective follow-up actions and changes in procedures and/or negotiations with payors.
• Ensures payment is received, credited and recorded at contracted rates. Identifies and researches discrepancies and provides feedback to leadership.
• Analyzes billing and accounts receivable reports. Identifies payor trends, categories of aged receivables and provides action plans to departments to improve results. Works with payors and follow-up personnel to train on revenue cycle metrics.
• Works with Legal to ensure proper payment is received.
• Analyzes reports on reimbursement and collections to identify opportunities for improved coding and billing. Makes recommendations for new procedures to appropriate management staff.
• Monitors insurance cash collections policies and procedures and educates Flight Coordination staff to ensure best practice sharing across company.
• Provides reports, feedback and analysis of on QA functions associated with reimbursement
• Meets regularly with revenue cycle leadership to address their reimbursement and data needs and recommends target areas for reimbursement analysis.
• Understands vendor revenue cycle contracts, tracks and trends vendor effectiveness and provides feedback to revenue cycle leadership.
• Presents reimbursement findings to senior leadership highlighting action plans and areas of opportunity.
• Drives various revenue cycle meeting agendas, creates action plans, and follows up on department meetings
• Directs reimbursement staff projects, areas of opportunity and reporting focus with the help of Revenue Cycle Director

Workflow / Process Improvement

• Ensures Revenue cycle goals and productivity standards are met for optimum utilization