Revenue Cycle Analyst

Job Overview: 

 The Revenue Cycle Analyst at Kolmac Integrated Behavioral Health and all its subsidiaries ("Kolmac" or the "Company") is responsible for ensuring that clearinghouse edits, denials, and payment posting is processed and completed in a timely manner.

Essential Duties and Responsibilities: 

• Post payments and rejections to ensure accurate posting 
• All 835 files must be posted daily along with checks that are received (manual and electronic)    
• Participate in month end processes to reconcile payments on a daily, weekly, and monthly basis
• Research all offsets, unapplied cash and all zero-dollar remits must be posted      
• Resolve and process overpayments, credit balances received from insurance co.
• Review insurance remittance advice for accuracy 
• Coordinate with insurance carriers to reconcile/resolve any issues      
• Must possess in-depth knowledge of EOB’s, copays, reason and remark codes, adjustments, write offs, EFT’s, ERA’s, and healthcare terminology 
• Complete all clearinghouse edits within 48 hours of receipt of the edit. 
• Interprets and evaluates appeals to include follow-up with payers to assure timely turnaround for claims resolution and reimbursement.
• Assist with identifying and escalating payer issues in a timely manner. 
• Processes and completes the daily workload of claims assigned, reporting backlogs as identified. 
• Identifies registration errors and reports all trends to management.
•  All work must meet QA and productivity standards to ensure departmental benchmarks are met. 
• Must be able to interpret explanation of benefits and have a clear understanding of payer methodology. 

• Ensure strict compliance with Medicaid, Medicare and all other Federal, State and Local regulatory procedures, certifications, and requirements, utilizing efficient and effective procedures and process controls. 
• Collaborates with Management and participates in process and quality improvement initiatives within the department 
• Other duties as assigned.

Qualifications - Education and Experience: 

• Must Haves:
•  Minimum 5 years’ experience working in a payment posting and accounts receivable environment for a private, nonprofit or public healthcare organization.
• Proficient in all Microsoft Office applications as well as medical office software.
• Proven experience in healthcare billing.
• Sound knowledge of health insurance providers, especially Medicaid and Medicare.
• Strong interpersonal and organizational skills.
• Excellent customer service skills.
• The ability to work in a fast-paced environment.
• Strong attention to detail and accuracy in all work products, including solid documentation skills that ensure proper audit trails.
• Strong oral and writing skills, including internal and external professional letters, transmittals, and other sensitive communications; and constructing and presenting professional highly sophisticated internal and external reports. 
• Flexible self-starter who can multi-task, while remaining focused and organized.
• Strong analytical skills, with experience integrating strategic vision into an operational model.
• Other duties as assigned.