Revenue Cycle Specialist / Payer Operations Specialist

1-3 years of end to end revenue cycle experience (Independent Laboratory and Telehealth preferred) including claim billing, claim auditing, and denial management.
Ability to read and interpret insurance explanations of benefits and utilize payer portals.
Knowledge of laboratory and physician payer enrollment processes including Medicare and Medicaid enrollment.
Working knowledge of CPTs, HCPCs, ICD-10, LCDs and Modifiers is a must.
Understands payor payment regulations including reimbursement schemes, coinsurance, deductibles and contractual adjustments.
Experience with Electronic Medical Record systems (EMRs), Athena Preferred.
Experience with Medicare, Medicaid, Managed Care Organizations, and Commercial Payers required.
Understanding CMS policy guidelines and state regulations as it pertains to RCM activities required.

Reviews claims on daily basis for completeness and accuracy.
Claim reporting and dashboarding to support KPI tracking.
Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
Identifies denial trends and additional process improvement opportunities to aid revenue cycle operations.
Data entry as required such as loading allowable schedules into EHR, manual claim entry, and new payer enrollment setup.
Contributes to and/or creates procedure manuals and standard operating procedures as applicable.
Supports payer enrollment as applicable including completing and following up on new payer enrollment applications.