EDGEWATER HEALTH

Discussion

Revenue Cycle Coordinator

Summary

Coordinates patient billing and insurance claims at a healthcare provider, ensuring accurate revenue cycle management with medical billing systems.

SUMMARY/OBJECTIVES

The Revenue Cycle Coordinator is responsible for coordinating, monitoring, and supporting the daily operations of the Revenue Cycle Department to ensure accurate patient registration, insurance verification, credentialing, coding support, claims processing, payment posting, denial management, collections, and provider enrollment activities. This position serves as a key resource in maintaining efficient revenue cycle workflows that maximize reimbursement while ensuring compliance with federal and state regulations, payer requirements, accreditation standards, and organizational policies.

The Revenue Cycle Coordinator works closely with clinical leadership, providers, finance, credentialing entities, insurance payers, to improve operational performance, reduce claim denials, improve cash flow, and support the overall financial health of Edgewater Health.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to, the following:

Revenue Cycle Operations

  • Coordinate day-to-day revenue cycle operations under the direction of the Revenue Cycle Manager.
  • Monitor the complete revenue cycle from patient registration through final payment resolution.
  • Review patient registration, demographic, and insurance information to ensure billing accuracy.
  • Monitor daily claim submissions and clearing house reports to identify and resolve claim rejections promptly.
  • Review billing edits and work queues to ensure timely processing.
  • Track and monitor accounts receivable (A/R) aging reports and assist with reducing outstanding balances.
  • Perform follow-up activities with commercial insurance, Medicare, Medicaid, Managed Care Organizations, and other third-party payers.
  • Research unpaid, underpaid, denied, or delayed claims and coordinate corrective action.
  • Assist with appeals, reconsiderations, corrected claims, and payer correspondence.
  • Monitor payment posting accuracy and identify payment variances.
  • Identify billing trends and recommend workflow improvements.

Compliance and Quality Assurance

  • Ensure compliance with HIPAA, CMS regulations, payer guidelines, FQHC requirements, behavioral health billing regulations, and organizational policies.
  • Assist with internal and external billing audits.
  • Maintain documentation supporting billing compliance.
  • Assist in monitoring coding accuracy and documentation requirements.
  • Identify compliance risks and report concerns to leadership.

Reporting and Analysis

  • Prepare routine reports on:
    • Claims status
    • Denials
    • Accounts Receivable
    • Payment trends
    • Credentialing status
    • Productivity metrics
  • Analyze reimbursement trends and identify opportunities for revenue improvement.
  • Assist with monthly financial reporting and revenue cycle metrics.
  • Monitor key performance indicators (KPIs) including:
    • Clean claim rate
    • Days in A/R
    • Denial rate
    • Net collection rate
    • First-pass resolution rate

Collaboration

  • Work collaboratively with clinical departments, finance, scheduling, registration, providers, and leadership.
  • Educate staff regarding payer requirements, billing procedures, and documentation standards.
  • Assist with onboarding and cross-training of revenue cycle staff as assigned.
  • Participate in departmental meetings and quality improvement initiatives.
  • Provide excellent customer service to patients, providers, insurance companies, and external agencies.

Other Duties

  • Maintain confidentiality of protected health information.
  • Participate in organizational committees as assigned.
  • Assist with special projects.
  • Perform additional duties as assigned by leadership.

REQUIRED COMPETENCIES-KSAS

Knowledge

  • Medical billing and reimbursement processes
  • Revenue cycle operations
  • Medical terminology
  • CPT, HCPCS, ICD-10 coding fundamentals
  • Insurance verification procedures
  • Medicare and Medicaid regulations
  • Commercial payer requirements
  • Behavioral health billing
  • FQHC reimbursement methodologies
  • Credentialing and provider enrollment processes
  • HIPAA Privacy and Security Rules
  • Electronic Health Records (EHR)
  • Revenue cycle software and billing platforms

Skills

  • Excellent analytical abilities
  • Strong organizational skills
  • Effective written and verbal communication
  • Critical thinking
  • Problem-solving
  • Time management
  • Data analysis
  • Customer service
  • Report preparation
  • Computer proficiency (Microsoft Office Suite, Excel, Outlook)

Abilities

  • Prioritize multiple competing deadlines.
  • Maintain confidentiality.
  • Interpret payer policies and billing regulations.
  • Work independently with minimal supervision.
  • Collaborate effectively across departments.
  • Identify process improvement opportunities.
  • Maintain accuracy under pressure.
  • Adapt to changing healthcare regulations.
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