Revenue Cycle Specialist - Claims Analyst
Under the supervision of the Patient Financial Services (PFS) manager and senior director my responsibilities include various aspects of receivable management for the PFS department. Working in a stratified process environment I collect, analyze, and report on data within the patient accounting system. Review specific cases, re-bill and follow-up with third party payers for accounts receivable.
- Handle all Medicaid, Medicaid HMO, Medicare, Medicare HMO, Blue Cross, and Commercial High Cost Outlier claims from billing to payment/resolution, ensuring effectiveness and accuracy of claim submission and processing for timely payment.
- Report, analyze, and resolve all High Cost Outlier claim denials for Medicaid, Medicaid HMO, Medicare, Medicare HMO, Blue Cross, and Commercial Insurance Carriers.
- Review ageing reports to ensure all accounts are being worked to payment/resolution.
- Communicate and work with inter/intra departments.
- Review/analyze weekly Medicaid payment report against projected cash, to find discrepancies and take steps to correction.
- Prepare, review and maintain HMO's payer grid for inpatient and outpatient claims.
- Prepare weekly High Cost Outlier spreadsheets
- Update credential for Medicaid providers on the NYS Department of Health website and ensure that accounts with updated information are rebilled for correct process and payment.
- Responsible for special project as assigned by Manager, Director a/o Vice President.