Revenue Cycle Insurance Specialist

Position Summary

The Revenue Cycle Insurance Specialist is responsible for resolving and collecting patient accounts, with a primary focus on those with a minimum balance of $10,000 (subject to change). This role also supports private pay account resolution once all insurance has been exhausted. The position requires advanced knowledge of account analysis, payer guidelines, and appeals processes.

Key Responsibilities

• Manage and resolve unassigned insurance accounts with a minimum balance of $10,000, as provided or located. NOTE: The Revenue Cycle Insurance Specialist must not take insurance account(s) that are assigned to original representative(s) unless the reassignment is initiated by the original representative and receives Director approval.
• Meet established production goals for both private pay and insurance fee requirements.
• Complete State Match daily.
• Analyze and follow up on unpaid or denied claims with commercial, government, and other third-party payers.
• Prepare and submit appeals, reconsiderations, and supporting documentation in accordance with payer requirements.
• Identify reason(s) for non-payment and take corrective action.
• Work on private pay accounts as assigned to completion.
• Maintain accurate and timely documentation of all account activity in compliance with company policies and procedures.
• Collaborate with coding, billing, and data processing departments to resolve discrepancies.
• Meet established productivity, quality, call auditing, claim auditing, and compliance standards.
• Stay current on payer regulations, billing guidelines, and applicable healthcare laws.

Qualifications

• High school diploma or equivalent
• Experience with medical collections and insurance filing/follow up.
• EOB knowledge and interpretation
• Experience with high dollar claims and appeals.
• Proficiency in EPIC and Microsoft Office applications

Skills and Competencies

• Problem solving skills and analytical thinking.
• Effective writing and verbal communication
• Attention to detail and accuracy.
• Ability to handle sensitive financial information with confidentiality.

Compliance Statement

Must comply with all applicable federal, state, and local laws and regulations, including but not limited to HIPAA, FDCPA and payer specific guidelines, as well as company policies and procedures.

Our Employment Practices

Diversified HealthCare Services, Inc. is an equal opportunity employer.

We value the different abilities, experiences and perspectives individuals bring to our organization and recognize that these differences strengthen our company and the service we provide for our clients.

Applicants for our positions are considered without regard to race, ethnicity, national origin, sex, sexual orientation, gender identity or expressions, age, disability, religion, military or veteran status, or any other characteristic protected by law.

Diversified HealthCare Services, Inc. maintains a drug-free and smoke-free workplace. Employment is contingent upon successful completion of applicable pre-employment requirements, including a drug screen and a background check.