Full job description
About us
Based in Boston, Massachusetts, Alico Healthcare is a specialized Revenue Cycle Management (RCM) and Healthcare Business Process Outsourcing (BPO) company. We partner with medical service providers and healthcare organizations nationwide, leveraging our expertise in medical receivables management to optimize their financial performance and streamline administrative processes, ultimately improving healthcare delivery.
Job Description
Position Summary:
The Revenue Cycle Specialist will report to the Healthcare Revenue Cycle Manager/Team Lead and will handle all functions related to collection of necessary claim documentation, claim submission, collections, and follow through on outstanding claims and cash applications; all actions relating to delinquent accounts, special adjustments, and/or write offs.
Job Responsibilities:
Billing and Posting:
- Bill and post-revenue payments/charges to insurance payors.
- Review and audit patient bills for accuracy and completeness; obtain any incomplete or missing billing information.
- Prepare, review, and transmit claims using automated systems and manual paper claim processes.
Authorization and Eligibility Verification:
- Obtain and track authorizations as appropriate.
- Ensure verification of eligibility and payor benefits.
Claim Management:
- Follow up on unpaid claims within the specified billing cycle timeframe.
- Validate insurance payments for accuracy and compliance based on contractual terms.
- Evaluate and investigate payor matters for any discrepancy in payments as necessary.
- Follow-up on payor-specific appeals and denial of claims.
Insurance Guidelines Knowledge:
- Possess knowledge of insurance guidelines, including HMO, PPO, Medicare, and state Medicaid.
Secondary Payors and Payments:
- Identify and bill secondary payors.
- Update cash spreadsheet, generate collection reports, and ensure compliant collection efforts interpreting the explanation for benefits (EOB).
Communication:
- Respond to all patient or insurance telephone inquiries to ensure timely reimbursement.
- Follow-up on all accounts with payor or patient to resolve any discrepancies or obtain necessary information.
Miscellaneous:
- Perform other duties as assigned.
Required Skills and Knowledge:
- Strong organizational skills.
- Attention to detail and accuracy.
- Knowledge of medical billing processes and insurance guidelines.
- Strong communication skills.
Job Type: Part-time
Experience:
- Medical Billing: 1 year (Preferred)
Education:
- High school or equivalent (Preferred)
Location:
- Massachusetts (Only)
Work Location:
- Remote
Hours per week:
- 30 Hours Per Week
Schedule:
- Monday to Friday 9:00 A.M – 3:00 P.M ET
Requirements
Qualifications:
- 1+ years of medical billing experience preferred
- High school diploma or equivalent
- Experience billing professional and physicians’ charges to insurance companies
- Experience reading electronic claim files
- Knowledge and competency to use medical claims clearinghouse system
- Possess strong organizational and follow up skills.
- Proficient with Microsoft Office products (Excel and Word)
- Familiarity with HCFA 1500 & UB-04