Revenue Cycle Specialist (50953)

JOB TITLE: Revenue Cycle Specialist

DEPARTMENT: Finance

POSITION SUMMARY

The Revenue Cycle Specialist is responsible for managing the revenue cycle processes to ensure timely, accurate, and compliant reimbursement for hospice services, with a primary focus on Medicare Part A billing and collections. This position oversees claims submission, payment posting, accounts receivable follow-up, denial management, and appeals while ensuring compliance with Centers for Medicare & Medicaid Services (CMS) regulations and organizational policies.

WORKING RELATIONSHIPS

REPORTS TO: Controller

SUPERVISES: None

INTERPERSONAL RELATIONSHIPS: All comments, actions and behaviors have a direct effect on the public’s perception of Hospice Austin. Interactions with patients, family members, physicians, referral sources, visitors, co-workers, etc. must be in a manner that is courteous, respectful, cooperative and professional. This behavior should promote an atmosphere of teamwork and positive relations.

ESSENTIAL FUNCTIONS

• Manage the complete Medicare Part A revenue cycle, including notice of election processing, billing, payment posting, accounts receivable follow-up, and reimbursement reconciliation.
• File Notices of Election (NOEs/81A) timely and accurately, review the Medicare Common Working File (CWF), and verify Medicare eligibility, certification periods, benefit days, and primary payer status.
• Coordinate monthly billing activities with Nursing, Clinical, and Administrative staff to ensure accurate and timely billing for all payers, with emphasis on Medicare Part A reimbursement.
• Perform pre-billing quality assurance reviews using established month-end accounts receivable checklists to ensure billing accuracy and compliance.
• Generate, review, and submit primary and secondary claims for Medicare Part A and other payers in accordance with CMS billing guidelines.
• Monitor claim status, research claim edits and rejections, resolve billing issues, and resubmit corrected claims to ensure timely reimbursement.
• Utilize Direct Data Entry (DDE), Medicare systems, clearinghouses, and other payer portals to research claim status and resolve outstanding accounts receivable.
• Prepare and process claim corrections, retroactive billing adjustments, reopenings, reconsiderations, and appeals as necessary.
• Run retroactive change reports and generate or adjust claims based on changes affecting reimbursement.
• Post Medicare payments, contractual adjustments, and remittance advice (ERA/EOB) accurately within the patient accounting system, including hospice per diem and consulting physician payments.
• Process consulting physician invoices and ensure accurate billing and payment reconciliation throughout the month.
• Monitor accounts receivable aging reports, investigate outstanding balances, and perform timely follow-up to maximize collections and reduce days in accounts receivable.
• Identify, investigate, and resolve denied, rejected, underpaid, or unpaid claims while documenting all account activity.
• Follow up on all services that have not been billed to ensure complete and timely claim submission.
• Bill charity care accounts in accordance with organizational policies and processes, approve charity write-offs, and bad debt adjustments.
• Verify patient insurance eligibility, benefits, and Medicare entitlement and ensure all required documentation supports medical necessity and billing requirements.
• Ensure compliance with CMS regulations, Medicare Administrative Contractor (MAC) requirements, HIPAA, and organizational policies.
• Maintain current knowledge of Medicare Part A regulations, hospice billing requirements, reimbursement methodologies, and industry best practices.
• Monitor revenue cycle key performance indicators (KPIs), identify reimbursement trends, and recommend process improvements to enhance operational efficiency and reduce denials.
• Maintain complete and accurate patient financial records and supporting documentation in the electronic health record and billing systems.