Revenue Cycle Specialist at Mount Auburn Hospital in Cambridge, Massachusetts

Principal Duties and Responsibilities

1. Codes charges from encounter forms. Codes descriptions accurately and in a timely manner

2. Reviews the encounter forms to identify the principal diagnosis, all secondary diagnoses, and major procedures. Refers to coding guidelines to resolve sequencing issues.

3. Resolves charge entry issues such as missing, unclear, or incomplete encounter forms.

4. Collaborates with appropriate resources to provide guidance and timely responses to provider coding, billing and documentation questions and requests.

5. Verifies demographic and insurance information of hospital based patients in assigned billing areas. Obtains referrals and authorizations for inpatient services when necessary.

6. Ensures the accurate and timely entry of charges and time of service payments.

7. Reconciles both charges and payments as defined in Revenue Cycle Policies. Identifies and corrects variances. Completes batch header forms and submits batches as per established protocols.

8. Develops and implements daily work plan to ensure timely and accurate charge entry.

9. Meets established deadlines. Assists providers in responding to changes in laws and regulations.

10. Works to promote uniformity in reimbursement policy throughout MAPS.

11. Together with the office manager, reviews and works denial reports. Recommends process improvements to reduce denials as appropriate.

12. Participates in related projects and attends required training and meetings.

13. May be required to float as staffing needs dictate

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

1. Associate's degree in a related field or equivalent in training and experience.

2. Physician billing experience necessary. Medical practice experience required.

3. Two years experience with charge entry and appointment scheduling software.

4. Knowledge of coding and reimbursement guidelines, medical terminology and HCFA regulations required.

5. Ability to effectively communicate with various levels of staff and customers.

6. Ability to work independently in a fast-paced environment.

WORKING CONDITIONS

1. Physical demands include ability to sit more than six hours per day.

2. Ability to communicate effectively. Ability to concentrate and focus in a busy practice environment.

3. Upper extremity demands include ability to perform data entry with repetitive hand movement, and visual concentration at video display terminal, to review and enter data.