Revenue Cycle Specialist

At PRC-Saltillo, we have a mission to provide voices to children and adults who are unable to communicate effectively with their natural voices.  Each year, we provide voices to thousands of individuals through our specialized communication devices and software.  We serve individuals with Autism, ALS, Cerebral Palsy, Aphasia and a variety of other conditions.  Our products not only provide the ability to speak, but open opportunities for education, vocation and simply fuller participation in life.

All applicants need to go to our website to apply www.prc-saltillo.com/careers

Position Summary:  The Revenue Cycle Specialist is responsible for the Company’s third-party medical claims processing.  Medical claims are prepared and submitted to Medicaid, Medicare, and private insurance companies.  This position will handle questions, complaints, or problems from insurance companies, Medicaid offices and their associated Managed Care Plans, Medicare regions and their associated Health Maintenance Organizations, and families regarding insurance payments. 

Duties and Responsibilities:

• Verifies all information for claims billing is correct in the billing software system and scans all billing documents into the document management database. Contacts the appropriate person to obtain missing or unclear billing information.  Documents all tasks in the required billing and document archiving databases.
• Reviews invoices to determine the correct billing method. Completes claim form through the party in question are complete and accurate.  Attaches required documentation for payment.
• Follows up by phone on all unpaid and denied claims through activities in the billing software. Determines next course of action per billing department protocols, which may require rebilling claims, denied claims, or sending additional information on pending claims.
• Handles third-party customer questions, complaints, and problems once an order has been invoiced. Completes all necessary follow-ups, so billing deadlines are not missed.
• Responds to and interacts with customers concerning all aspects of billing through phone, email, or regular mail in a prompt and courteous manner.
• Relays changes in Medicaid, MCO, Medicare, HMO regulations discovered by claim denials to all pertinent personnel including funding internal teammates.
• Filing for the department.
• Relays updated information regarding state policy changes to the department.
• Maintains confidentiality outlined in privacy portion of the federal Health Information Privacy and Portability Act of 1996.
• Performs other duties as assigned.
  

Required Skills/Abilities:

• Possess the ability to work in a constantly changing environment, good judgement skills, and capable of making decisions.
• Must have excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy.
• Excellent verbal and written communication skills.
• Must have excellent analytical and problem-solving skills.
• Ability to work easily and cooperatively with other departments.
• Ability to work independently and follow through on tasks without direct supervision.
• Ability to work well under pressure in a flexible, diplomatic, and expeditious manner.
• Must be extremely accurate with attention to detail, policies, and procedures.
• Excellent and accurate calculator and computer/keyboard skills, including the ability to use Microsoft Excel, Word, and email.
• Good overall knowledge of Company departments and their functions.  

Education and Experience:

• High school diploma or equivalent is required.
• Billing Certificate or 6 months medical billing experience is required.
• Minimum of 5 years of work experience at PRC-Saltillo is desirable (if not previous billing experience or billing certification).
• Must be knowledgeable in billing databases.