Revenue Cycle Transaction Specialist

Job Summary

Responsible data entry for medical billing from insurance companies (payors) and patients. Serves as a liaison between practices, clinics, the business office, payors, and patients. Establishes and maintains contacts with payor accounts’ representatives. Initiates telephone contact and answers all calls pertaining to accounts. Maintains accurate information regarding patient accounts receivable. Maintains strict confidentiality for all patient accounts. Follows approved processes, policies and procedures in executing job duties.

• Responsible for accurate and timely posting of patient and insurance transactions including charges, payments, adjustments and refunds into the practice management system.
• Processes patient and insurance refunds and issue refund checks to appropriate parties.
• Keys data into computer to maintain billing records and prepare insurance form with data such as names of insurance company and policy holder, policy number, and physician diagnosis.
• Contacts insurance company to verify patient coverage and obtain information concerning extent of benefits.
• Generates appropriate paperwork, including insurance claim forms (original and re-filed) and collection letters, and mails monthly statements to patients.
• Reviews insurance claim forms for accuracy, retrieving and attaching appropriate dictation for claim, as needed.
• Reviews insurance payments (Explanation of Benefits – EOB’s), including Medicare and Medicaid payments for accuracy in account information and demographics.
• Determines adjustments of claims paid at the out-of-network rate to in-network rates, and processes write-offs on these adjustments.
• Answers patients’ questions regarding statements and insurance coverage, answers telephone in a prompt, courteous, and helpful manner, screening calls, directing calls, providing information, answering questions, and taking accurate messages.
• Responds to all inquiries received from patients and payors either by telephone or written request.
• Follows-up on unpaid insurance claims after denial, to obtain settlement of claim.
• Establishes and maintains contacts with payor accounts’ representatives.
• Reviews accounts receivable activities and calls on outstanding balances or claims.
• Handles transactions necessary on discharged patients.
• Completes and files all necessary paperwork for services rendered, i.e., charge tickets, patient forms, medical records, etc.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.