Revenue Cycle Specialist - Full Cycle Management

Responsibilities

• The successful candidate will be able to:
• Claims Processing:
• -Review all patient insurance information needed to complete the billing, collections, appeal, and/or cash
• processes to ensure clean claims submission to insurance carriers
• -Review all charges, coding and prepare for claims for electronic submission
• -Work error reports from clearing house
• -Resolve billing edits for clean claim submission
• -Obtain required attachments for claims submission from various EMR's
• -Verify insurance coverage and eligibility for patients
• Accounts Receivable Follow-up:
• -Resolve billing discrepancies and claim denials through follow-up with insurance companies
• -Maintain clear communication with management about billing and insurance details
• -Review and interpret dental EOBs (Explanation of Benefits), including patient deductibles, co-pays, and
• insurance/third-party correspondence
• -Research and navigate insurance policies, benefits, and exclusions to provide accurate information to
• patients & management team
• -Monitor outstanding claims and follow up with insurances to ensure timely payments
• -Follow up to all third-party payers and self-pay accounts documenting appropriate information thoroughly
• on accounts
• -Demonstrate a professional image in dealing with the public, patients, clinical offices, and insurance
• carriers
• -File all secondary insurance claims with appropriate EOB's daily to avoid timely denials
• -Review credit-balance accounts on a weekly basis
• -Submit corrected claims or appeals to Insurances carriers for both Medical & Dental
• -Performs appropriate adjustments, when required
• -Gather payor trends and provide feedback to management
• -Identify and resolve specific coding issues, providing feedback to management
• -Work with internal revenue cycle and administrative teams to identify and manage 3rd party payor denials,
• overpayment, and underpayment issues
• -Contact patients regarding coordination of benefits, insurance payments mailed to patient, and outstanding
• patient balance
• Claims Resolution & Claims Correction:
• -Post denials within required timeframe accurately into each practice management system
• -Analyze and resolve insurance claim denials, including underpayments and rejections
• -Track and document all actions taken on denied claims within the billing system
• -Communicate with leadership, patients, and insurance representatives to clarify billing discrepancies
• -Identify trends and provide feedback to improve claim submission processes and reduce denials
• -Communicate with healthcare providers, patients, and insurance representatives to clarify billing
• discrepancies
• -Manage claim denials related to authorization, medical record
• Patient Billing & Collections:
• -Utilize phone etiquette to communicate effectively with patients regarding their accounts
• -Assist patient billing & collections team to answer patient calls during high volume inbound calls periods
• -Process credit card payments
• -Make outbound self-pay collection calls to patients regarding outstanding balances
• -Perform any and all other duties as assigned

Requirements

• -High School Diploma required, Medical Billing and/or Coding Certification highly preferred
• -3+ years of hands-on experience in healthcare revenue cycle management, with a proven track record of
• optimizing processes
• -1 year experience using Dental Software Network (DSN)
• -Proficient in all Microsoft Office applications as well as medical office software
• -Proven experience in healthcare billing
• -Sound knowledge of health insurance providers
• -Strong interpersonal and organizational skills
• -Excellent customer service skills
• -The ability to work in a fast-paced environment
• Perks of the Job:
• -Highly competitive salaries & annual performance and compensation reviews
• -Competitive health insurance and benefits, including medical, dental, vision, disability, and more
• -401k retirement savings plan that includes employer match
• -Generous Paid Time Off, sick leave, and paid holidays
• -Advance your career growth with opportunities in the most extensive growing oral surgery practice in the
• Northeast
• About MAX Surgical Specialty Management:
• Established in September 2022 as the Northeast region's first oral and maxillofacial surgery-only specialty platform, MAX Surgical Specialty Management is a surgeon-led management services organiz

Additional Information

Join MAX Surgical Specialty Management, an innovative leader in the healthcare industry, as we embark on an exhilarating journey of growth and expansion! We are seeking a motivated and dynamic individual to join our Revenue Cycle Management Team as a Revenue Cycle Specialist-Full Cycle Management.

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