Revenue Cycle Management Specialist I at CORE PLUS LLC – Carolina

Revenue Cycle Management Specialist I

Who are we?

For more than 26 years, CorePlus has provided Puerto Rico with anatomical pathology laboratory services and clinical analysis with innovation and precision. Our commitment is, to be a leader in the transformation of pathology to the digital world.

In 2020 we deployed our digital pathology platform, being the first organization in Puerto Rico to make the transformation. Known worldwide for operationalizing the use of Artificial Intelligence (AI) in the diagnosis of prostate and breast cancer, CorePlus stands out for being avant-garde.

If innovation and compassion appeal to you, we invite you to join our mission and become part of our family; we offer excellent benefits including health plan, dental, vision, 401k, paid vacation, and life insurance.

The Position

The Revenue Cycle Management Specialist is responsible for overseeing and optimizing the financial aspects of a healthcare organization's revenue cycle. They play a crucial role in ensuring that the organization receives proper reimbursement for medical services provided to patients. This involves managing the billing and collections process, resolving any billing issues, and ensuring compliance with relevant regulations and policies.

Responsibilities

1. Accurately code and submit claims to insurance companies and government payers following industry guidelines and coding standards.

2. Monitor the status of submitted claims, identify, and resolve claim denials or rejections, and ensure timely resubmission if necessary.

3. Handle patient billing inquiries, provide explanations of charges, and assist patients with payment arrangements and financial assistance options.

4. Monitor and analyze accounts receivable, follow up on overdue payments, and implement strategies to reduce outstanding balances.

5. Ensure compliance with healthcare regulations, privacy laws, and payer requirements throughout the revenue cycle process.

6. Identify opportunities for revenue enhancement, such as improving coding accuracy and maximizing reimbursements.

7. Generate and analyze revenue cycle performance reports to track key performance indicators and identify trends or areas for improvement.

8. Collaborate with various stakeholders, including medical staff, billing departments, and insurance companies, to facilitate smooth revenue cycle operations.

Requirements and Skills

1. Education: Bachelor's degree in healthcare administration, finance, or a related field. Some positions may require additional certifications in revenue cycle management.

2. Experience: Previous experience in revenue cycle management, medical billing, or healthcare financial services is preferred.

3. Knowledge: Proficiency in medical coding systems (e.g., CPT, ICD-10), billing processes, and healthcare regulations (e.g., HIPAA, Medicare, Medicaid).

4. Analytical Skills: Ability to analyze financial data, identify trends, and make data-driven decisions to optimize revenue cycle performance.

5. Communication: Strong verbal and written communication skills to interact effectively with patients, insurance companies, and internal staff.

6. Problem-Solving: Capacity to identify and resolve billing issues and denials in a timely manner.

7. Attention to Detail: A meticulous approach to ensure accuracy in coding, billing, and financial records.

8. Technology Proficiency: Familiarity with healthcare management software, electronic health records (EHR), and billing systems.

Working Conditions/ Physical Activity:

• While performing the duties of this job, the employee is regularly required to talk and listen.
• The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, crouch or crawl.
• The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

CorePlus is an equal employment/affirmative action opportunity employer. It does not discriminate against any qualified person on the basis of sex, race, color, national origin, religion, sexual orientation, age, marital status, mental, physical or sensory disability, or any other classification protected by applicable local, state, federal, and/or international law.