Description:
RESPONSIBLE FOR:
The Revenue Cycle Representative III (Rep III) is a multi-tasking advanced position that encompasses all key functions of the physician billing Revenue Cycle. The Rep III position requires advanced revenue cycle knowledge that has been acquired through experience and developed through training and education. The Rep III supports patient-centered care and Customer Service by serving as a patient advocate during the life cycle of the account. The Rep III is expected to maintain productivity above the average standard identified by the Revenue Cycle Department. Quality and accuracy of work performed by the Rep III is expected to be consistently above 90% when audited. Rep III performance will be measured according to the Piedmont Healthcare values of Compassion, Commitment, Service, Excellence, and Balance and expected to be tiered in the top 1/3 in the department.
Rep III Revenue Cycle duties may include but are not limited to Core Functions: Billing, Claims Filing, Data Entry, Charge Entry, Insurance Follow-Up, Self-Pay Follow-Up, Denial Management, Payment Posting, Refund Management, Credit Balance Management, Account Correction and Adjustment, Response to Patient Account Inquiries, Customer Service Advocacy, Self-Pay Collections, and Unapplied Cash, as well as Advanced Functions: File Maintenance, System Support, Claims Edit Management, Claims Rejection Management, Front End Management, and Payment Variance Management.
The Rep III Employee will be proficient in one or more advanced Revenue Cycle responsibilities or functions. Advanced Revenue Cycle responsibilities and functions are those above and beyond that of Core Revenue Cycle functions.
Qualifications:
MINIMUM EDUCATION REQUIRED:
High School graduate or GED.
MINIMUM EXPERIENCE REQUIRED:
Requires a minimum of 5 (five) years of experience exhibiting advanced performance in a physician billing revenue cycle or Central Business Office.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None.
ADDITIONAL QUALIFICATIONS:
Advanced knowledge of third-party insurance in regards to plan types: HMO, PPO, POS, and Indemnity. Excellent knowledge of the Medicare Program particularly as it relates to CPT and ICD9 coding. Thorough knowledge of Medicare Fraud and Abuse regulations. Ability to counsel patients financially regarding outstanding charges and effectively resolve problems via the highest customer service skills and etiquette. Possesses advanced knowledge of the Practice Management System. Possesses the ability to run standard reports in order to answer questions from practice managers and physicians. Possesses thorough knowledge of HIPAA regulations. This job requires proficiency with the computer systems that are used in the practice including Practice Management System, Internet products that relate to office functions, and Microsoft Office systems available to the office.
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