Revenue Cycle Specialist en Suncoast Community Health Centers Inc.

POSITION TITLE: REVENUE CYCLE SPECIALIST

FLSA: NON-EXEMPT

Job Summary:

A Revenue Cycle Specialist is responsible for managing and processing invoices, payments, and financial records to ensure the accurate and timely billing of services rendered. This role involves verifying revenue cycle data, resolving discrepancies, and coordinating with clients, insurance companies, and internal departments to handle accounts receivable. The Revenue Cycle Specialist ensures compliance with relevant regulations, assists with audits, and maintains detailed financial records.

Duties/Responsibilities:

• Generate and process accurate invoices for services provided.
• Ensure all billing information is complete and accurate, including service codes, charges, and patient information.
• Review and verify revenue cycle data for errors or inconsistencies and correct them as needed.
• Monitor accounts receivable and track outstanding payments to ensure timely collection.
• Reconcile payments and resolve any discrepancies in accounts.
• Coordinate with patients or insurance companies to resolve billing issues and follow up on unpaid invoices.
• Handle billing for Medicare, Medicaid, and private insurance, including submitting claims and verifying insurance eligibility.
• Ensure compliance with insurance reimbursement regulations and follow up on denied, appeals and delayed claims.
• Review any claims aged over 90 days.
• Prepare and submit claims with proper coding (CPT-4, ICD-10) and documentation as required.
• Maintain accurate financial records, including invoices, payment histories, and billing reports.
• Scan and maintain electronic images of paper remittance vouchers.
• Assist in audits by providing necessary financial documentation and reports.
• Ensure billing practices comply with company policies, government regulations, and industry standards.
• Ensure revenue cycle practices comply with SCHC policies, government regulations, and industry standards.
• Communicate with patients to clarify billing information, resolve discrepancies, and update account details.
• Provide customer support regarding billing questions and payment options.
• Work closely with internal teams such as finance, customer service, and management to address billing-related concerns.
• Prepare regular reports on revenue cycle performance, outstanding accounts, and collection efforts.
• Analyze billing data to identify trends, inefficiencies, and areas for improvement.
• Recommend and implement process improvements to enhance the accuracy and efficiency of revenue cycle operations.
• Use revenue cycle software and electronic medical record (EMR) systems to process and manage revenue cycle
• Perform additional tasks as needed to support the centers.

Required Skills/Abilities:

• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Strong analytical and problem-solving skills.
• Collaborate with IT and finance teams to troubleshoot issues with billing systems.
• Stay updated on software updates and best practices to optimize billing processes.
• Ability to use office equipment, including computers, copy machines, fax machines, telephones, calculators, and more.
• Must be able to effectively manage workflow and maintain high-quality standards in environments where staffing levels may be below ideal, demonstrating the ability to prioritize tasks and collaborate with the team under pressure.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to function well in a high-paced and at times stressful environment.
• Proficient with Microsoft Office Suite, Electronic Medical Records (EMR) and related software.

Education and Experience:

• High School diploma or equivalent
• At least three years related experience required.
• Proficiency in billing software, EMR systems, and Microsoft Office (Excel, Word, Outlook and similar software)
• Familiarity with Medicare, Medicaid, private insurance reimbursement, and coding systems.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.
• Must be able to travel to various center locations as required.