Revenue Cycle Specialist Resume Samples

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Revenue Cycle Specialists are found in the healthcare industry ensuring the financial integrity of hospitals and clinics. Essential duties highlighted on a Revenue Cycle Specialist resume sample are ensuring compliance with relevant laws, following reporting standards, coordinating multiple departments within the facility, and finding ways to make healthcare sustainable. A well-written resume example in the field should mention qualifications like financial expertise, knowledge of healthcare issues, organizational skills, computer competences, problem solving, and analytical thinking. Most Revenue Cycle Specialists have a background in finance, accounting, and business.

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1

Revenue Cycle Specialist

Assisted in analyzing and developing improved revenue performance for practices through the United States.

  • Worked with individual practices to adopt best practices and improve existing processes.
  • Conducted on-site visits to analyze and improve processes and utilization of system functions.
  • Develop new Policies and Standard Procedure.
  • Monitoring Revenue Cycle Management ensure that goals are met.
  • Integrate and train staff on new functionality such as Charge Capture to streamline the processes at the practice.
  • Acted as a liaison between the Practice and the Home Office to ensure the RCM Goals are met and that implementation are completed in a timely manner.
Candidate Info
11
years in
workforce
2
years
at this job
AS
Business Administration
BS
Business Administration And Management
2

Revenue Cycle Specialist-contract

  • Achieved Company goal working Medicare of nearly $1.2B reduced to AR of $785M within 3-month span.
  • Cash performance FY2017 reflected slightly over $1.6B.
  • Maintained inventory >60 days metric starting at 40% and currently at 15%
  • Analyze denied claims, resubmit claims, document claim statuses, request medical records, file appeals, redeterminations, etc.
  • Managed six (6) Hospitals from Dignity Health on the west coast working Inpatient, Outpatient, SNF, Ambulatory Surgery, etc.
  • Proven record of 95% or above on Quality Assurance scores every Month.
  • Progressive experience in third-party, managed care, Medicare, Medicaid, Commercial payers, collections, UB04/1500billing procedures, cash applications, balancing and reconciliation processes.
  • Task accounts to vendor seeking approval for CCI billing edits before process of claim.
  • Research overlapping dates on claim and change occurrence codes, if necessary prior to submitting claims.
  • Task to confirm supporting DX for denied line items before resubmitting corrected claim.
Candidate Info
18
years in
workforce
9
months
at this job
BA
Business Admin / Management
Certification
3

Revenue Cycle Specialist

Reviewed all unpaid claims to keep them from aging past 60-90 timeframe

  • Processed/Sent and Received medical records for denied claims with anesthesia reports or trip reports
  • Follow-up on Government Medicare Advantage plans regarding payments and adjustments
  • Adjusted balances left on outstanding claims per contracted rates
  • Submitted correct claims to be reconsidered for payment
  • Worked extensively with Worker's Compensation
  • Worked with Attorneys and 3rd Party Vendors extensively
Candidate Info
11
years in
workforce
6
months
at this job
HS
Computerized Medical Office Administration
4

Revenue Cycle Specialist

  • High level understanding of insurance benefits and payment guidelines
  • Obtained and maintained all referrals and pre-authorizations to ensure adequate reimbursement
  • Maintained insurance verifications, cash posting and collections
  • High level of understanding of insurance coordination of benefits and reimbursement
  • Implemented new ideas and procedures for efficient workflow
  • Established and maintained relationships with new clients as well as patients
  • Successfully and efficiently maintained accounts to ensure adequate reimbursement
  • Extensive work with insurance payers to ensure proper billing and payment guidelines
  • Collected over $300,00 in past due accounts via private pay patients as well as insurance payers
Candidate Info
9
years in
workforce
1
year
at this job
AS
Basic
5

Payment Poster/revenue Cycle Specialist( Short Term Contract Positions)

Reviewed delinquent accounts, documented and updated changes

  • Proficient in mandatory laws and regulations in processing Medicaid/Medicare/Commercial claims
  • Collected payments on overdue accounts
  • Maintained patient account balances based on required time frames
  • Managed delinquent accounts initiating collections procedures as required
  • Gathered medical records to input and update patient information In computer system
  • Reported patient and payer credit balances on weekly, monthly basis
  • Utilized the NexGen/Epic/Allscripts PM Medical accounting software systems
  • Updated and tracked progress on patient accounts via spreadsheets-Excel
Candidate Info
14
years in
workforce
9
months
at this job
HS
Medical Coding And Billing Insurance
6

Revenue Cycle Specialist

  • Review both obstetrical and gynecology ultrasound records to ensure accuracy in CPT and ICD diagnostic codes to ensure proper reimbursement
  • Review medical records to ensure accuracy in CPT and ICD diagnostic codes for gynecology office and hospital procedures for providers to ensure proper reimbursement for surgical and other specialized, complex procedures.
  • Collaborate with providers to resolve clinical documentation inaccuracies, incomplete documentation and corrections when necessary.
  • Collaborate with billing department to resolve insurance denial and other billing questions.
  • Promote adherence to industry regulations and maintains awareness of current industry trends in order to provide feedback and/or education to physicians and administrative staff.
  • Identify opportunities for improvement in staff performance and processes based on analysis of insurance denials.
Candidate Info
6
years in
workforce
8
months
at this job
BA
Finance And Management
Medical Billing And Coding
7

Revenue Cycle Specialist

  • Extensive Knowledge of all insurance payers (BCBS, Managed Care, Commercial, Medicaid, Medicare, and Workers Compensation)
  • Knowledge of Provider Credentialing and Contracts with HMO Payers
  • Researched Insurance Payers to identify requirements for clean claims submission
  • Established procedures to ensure sound collection of receivables
  • Created Spreadsheets to track denial trends, missing/underpayments and unapplied payments
  • Interacted with the Clinical staff and Patients to obtain additional information needed to process claims
  • Identified accounts requiring collection agency or legal action and coordinate collections with third party contractors
  • Processed Credit Refunds/Contractual Adjustments and Discounts.
  • Complies with department safety policies and procedures to help ensure that the safety and physical well-being of patients, family members, visitors and co-workers are maintained
Candidate Info
19
years in
workforce
2
years
at this job
8

Revenue Cycle Specialist

  • Recieving denied claims and correcting errors for resubmission
  • Sumbitting claims electronically and by mail
  • Emailing / calling clinical office sites to obtain correct Patient information for claims
  • Verifying insurance eligibility for each patient for claims to be submitted
  • Working with insurances such as but not limited to: Mass Health, Network Health, BMC, Neighborhood Health, and Commonwealth Care Alliance
Candidate Info
6
years in
workforce
6
months
at this job
HS
High School Diploma
C
Medical Assistant
9

Revenue Cycle Specialist

  • Liaison between the insurance companies and the physician's offices with regard to pre-authorizations, billing, collections, refunds, and client relations in order to maximize quality and value for clients.
  • Monitoring and review of open account receivable to identify adjustments, refunds, and payment breakdown amounts.
  • Communicate with carriers, physician's offices, patients, and management to achieve resolution of issues and claim payment.
  • Meet and maintain accuracy, productivity and turn-around standards established for the department.
Candidate Info
8
years in
workforce
1
year
at this job
Medical Billing And Coding Specialist Graduate
Business Administration
10

Revenue Cycle Specialist

  • Handle inbound calls and schedule patient appointments
  • Verify insurance and patient information
  • Collect payments and maintain cash drawer
  • Communicates effectively and respectively with patients and team members
  • Provides exceptional customer service
Candidate Info
14
years in
workforce
3
years
at this job
HS
High School Diploma
AA
Arts And Sciences
BA
Business Administration

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