510 Roosevelt Avenue, American Falls, ID 83211   208-226-3200  EMERGENCY CALL: 911

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Job Details

Revenue Cycle Specialist (Full-time)

Description

Responsibilities:

  • Payer Credentialing
    • Accurately complete and timely submit credentialing (and re-credentialing) applications for both providers and facilities.
      • Medicare, Medicaid, and various commercial and other insurance plans
    • Initiate and maintain CAQH (Council for Affordable Quality Healthcare) files on all Providers
    • Maintain files with provider and facility licenses, malpractice insurance and other supporting documentation.
    • Maintain copies of all credentialing applications and important correspondence.
    • Track and manage credentialing dates to ensure re-credentialing is started and completed in a timely fashion.
    • Actively seek out information on insurance plans being offered in our area (both employer and healthcare exchange) and work to complete credentialing for them.
  • Facility and Provider directory maintenance
    • Provide complete and accurate information to payers to facilitate correct listings on their websites.
    • Periodically review insurance company directories to ensure our providers and facilities are all listed and the information accurate and up to date. Work with insurance companies to remove inactive providers and fix incorrect information.
    • Periodically review CMS and Medicaid websites (NPPES NPI registry, PECOS, etc.) to ensure our providers and facilities are all listed and the information accurate and up to date. Work with the appropriate agencies to remove inactive providers and fix incorrect information.
  • Contract Management
    • Collect and maintain copies of all insurance contracts and amendments.
    • Create and maintain a summary comparison tool of insurance contracts (for easy comparison)
    • Assist in the review, comparison, and analysis of proposed insurance contracts
  • Revenue Cycle Assurance
    • Forward the most current Medicare rate letters to Medicare Advantage plans.
    • Use online tools available from payers to verify contracted rates and utilize information to assist in establishing and/or revising Chargemaster rates.
    • Periodically audit payments from Medicare, Medicare Advantage and commercial plans to ensure we are being paid according to the most recent contracted rates.
    • Work with CFO, Patient Accounting supervisor, and payer representatives to address and resolve any payment/reimbursement issues.
    • Work with Patient Accounting Supervisor to resolve and dispute payment denials. This may involve:
      • Assisting in researching the issue, locating and providing additional information to the payer.
      • Assisting in the evaluation (and possible revision) of internal workflows and processes to prevent future issues.
    • Work with Revenue Cycle team to help drive improvements in the charge capture process.
  • Other Duties
    • As time and workload permits:
      • Assist with Billing and Insurance Processing
      • Assist with updating and maintaining facility Chargemaster

Qualifications

Experience:

  • Experience in Healthcare Billing and/or Credentialing preferred

Requirements:

  • Impeccable organizational and time-management skills
  • Strong attention to detail
  • Excellent verbal and written communication skills
  • Able to self-start, multi-task and meet tight deadlines
  • Ability to work both independently and collaboratively within a team environment
  • Excellent problem-solving skills
  • Proficiency with Microsoft Office Suite, including Outlook, Excel & Word

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Human Resources
(208) 226-3203 ext 202 & 204
fax (208) 226-7413