Revenue Cycle Lead
Summary of Major Responsibilities
The Revenue Cycle Lead is responsible for supporting the Revenue Cycle Supervisors and Revenue Cycle Department. The primary responsibility of the Revenue Cycle Lead is to support the timely and accurate submission of claims, appeals, and cash posting, monitor performance, provide training and coordinate workflows. This position is designed to be highly cross-functional and is a “working” Lead position with expectations of working alongside staff as well as provide direction.
Essential Duties and Responsibilities
- Responsible for oversight of daily activities as they relate to the Revenue Cycle Team.
- Assist in training and evaluating RC department staff. Develop and maintain procedures for efficient and accurate processing of claims, processing appeals, posting cash, and other functions as necessary.
- Perform ad-hoc audits as needed.
- Processes billing transactions in a timely and productive manner, meets production goals and month end processing requirements.
- Keeps supervisor(s) informed of any work problems and issues.
- Monitor work queues to ensure tasks are being performed in a timely manner.
- Handle escalated matters prior to Supervisor involvement.
- Understands external rules and regulations as they relate to healthcare billing and collections e.g. Medicare, Medicaid, state laws, Health Insurance Portability and Accountability Act (HIPAA), etc.
- Ensure compliance with all Company procedures and guidelines including but not limited to Code of Business Conduct and Ethics.
- Act as Subject Matter expert and assist in educating team on system(s), workflows and guidelines.
- Follow-up and investigate any errors/issue and work with respective team members/supervisors for resolution.
- Suggest billing process/workflow updates/changes as necessary.
- Follow attendance guidelines and in good standing (internal).
- 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 (ie Special Projects, high volume functions along with constant Client and People Skill maintenance).
- Work with all areas of the department to assure maximum productivity.
- Demonstrates good skills in all forms of communication.
- Works well with others in a spirit of teamwork and cooperation.
- Complete other duties as assigned.
Mandatory Skills & Qualifications
- Demonstrated knowledge of medical billing principles and practices.
- Solid understanding of payer categories included Medicare, Medicaid, Medicare Advantage and Insurance Payers.
- Knowledge of International Classification of Diseases (ICD-9) an (ICD-10).
- Knowledge of Coding Procedure Terminology (CPT).
- Familiarity with Explanation of Benefits (EOB); must be able to read and interpret explanation of benefits (EOB) for all payors.
- Ability to teach and train.
- Demonstrated ability to work independently.
- Excellent written and verbal English communication skills.
- Excellent telephone etiquette required - Answers telephone calls in a timely and courteous manner.
- Demonstrated ability to read and comprehend written instructions.
- Disciplined, self-motivated & reliable; able to stay focused on a task and work independently; motivated to perform quality work; diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
- Possesses a positive attitude with excellent interpersonal skills and the ability to interact and build strong working relationships with customers as well as peers at all levels of the organization.
- Ability to work in a team environment and adapt to changing workload and circumstances effectively; able to respond to new information quickly.
- Employee in good standing – no attendance issues, no performance improvement plans in the last year.
- Professionalism: conducts themselves in a professional manner in all interactions with members of the Exact Sciences team, clients and associates.
- Attend staff meetings or other company sponsored or mandated meetings as required.
- Ability to operate telephone system, fax machine, printer, scanner, personal computer, photocopier.
- Demonstrated ability to work in Microsoft applications (Word, Excel, Power Point).
- Perform additional duties as assigned.
Necessary Education & Experience
- High School diploma or GED.
- Experience in a role that required frequent keyboard use/typing skills.
- Minimum 2 years of experience directly or indirectly leading others.
- Experience with data entry on 10 key.
- Previous experience working with billing software.
- 4+ years’ medical billing and collections experience preferred.
- Associate Degree, Vocational/Technical degree or certification preferred.
- 3+ years medical billing experience within the health care industry is highly preferred.
- Demonstrates initiative and willingness to continuously improve processes.
Physical Requirements & Working Conditions
- Position requires work in normal office environment.
- Work is generally sedentary in nature, but may require standing and walking for up to 10% of the time.
- Subject to long or irregular hours.
- Subject to frequent interruptions.
Exact Sciences is 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 is available to any applicant or employee for inspection upon request.
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