Medical Systems Specialist

Summary of Major Responsibilities

This position reports to the Revenue Cycle Manager and partners closely with the Data Integrity Specialist to ensure timely file maintenance of the software systems uses to support the Revenue Cycle Department. The File Maintenance Specialist also assists Revenue Cycle Leadership in managing workflows and projects as assigned.

Essential Duties and Responsibilities

  • Create and maintain payor and client master files to ensure accurate and timely updates or changes.
  • Investigate and resolve electronic remittance errors.
  • Monitor error reports and resolve issues that relate to billing file maintenance including but not limited to payor interface errors, system related eligibility error messages, and manual pricing releases.
  • Report and suggest file maintenance changes to Revenue Cycle Leadership and Revenue Cycle staff as needed.
  • Work closely with vendor and payor partners to identify and resolve systematic issues.
  • Ensure compliance with all Company procedures and guidelines including but not limited to Code of Business Conduct and Ethics.
  • Stay current with relevant guidelines and policies for medical billing.
  • Work with all areas of the Customer Care Center to ensure maximum productivity.
  • Conduct all assigned job duties in a timely and productive manner.
  • Perform all job duties according to department policies and procedures.
  • Provide extra resource when needed within the department.
  • Demonstrates good skills in all forms of communication.
  • Works well with others in a spirit of teamwork and cooperation.
  • Completes position responsibilities by following established guidelines and protocols within the appropriate time frame.
  • Complete other duties as assigned.


Mandatory Skills & Qualifications

  • Excellent written and verbal English communication skills and the ability to professionally communicate with vendor partners.
  • Demonstrates analytical skills and critical thinking abilities (i.e. to identify payor payment inconsistencies or other issues proactively; to comprehend billing ledgers of charges, payments and adjustments.
  • Demonstrated ability to work independently.
  • Demonstrated ability to create and maintain logs/charts in an accurate, organized and effective manner.
  • Demonstrated expertise using Microsoft Excel.
  • Demonstrated ability to read and comprehend written instructions.
  • Demonstrated ability to successfully manage multiple priorities/projects at one time and ability to handle pressure of deadlines and complex issues in an effective way.
  • Demonstrates strong dedication to ethics and following processes and procedures.
  • Demonstrated ability to collaborate and work effectively with all levels of the organization in the spirit of teamwork and communication.
  • Completes position responsibilities by following established guidelines & protocols.
  • Overtime initiative when needed.

 Necessary Education & Experience

  • High School diploma or GED.
  • Minimum of 1-2 years of experience in systems file maintenance, preferably medical billing systems.

Desired Characteristics

  • Some college course work preferred but not required.
  • Demonstrates initiative and willingness to continuously improve processes.


EEO Disclosure

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, creed, disability, gender identity, national origin, protected veteran status, race, religion, sex, sexual orientation, and any other status protected by applicable local, state or federal law. Applicable portions of the Company’s affirmative action program are available to any applicant or employee for inspection upon request.

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