Ambulatory Services Reimbursement/RAC Coordinator

ROLE SUMMARY

The Ambulatory Services Reimbursement/RAC Coordinator is responsible to ensure that Cheyenne Regional Medical Group is reimbursed correctly per payor contracts to assist in proper revenue cycle process.

CORE RESPONSIBILITIES

1. Provide exemplary customer service while working with patients, and/or guarantors, and insurance companies appropriately concerning billing issues. Demonstrate positive interpersonal communication skills relating to internal and external customers on the telephone. Communicate in a courteous, accurate and honest manner. Handle customer service complaints in a professional manner. Adhere to Cheyenne Regional Medical Center Service Excellence standards. Actively participate in all team meetings, including team building activities

Compose and submit appeals to third party payers, appealing to the highest level to resolve account denial for proper reimbursement. Maintain RAC denials database information in Microsoft Excel. Perform application maintenance using: imports and exports of files in excel, text delimited and database format. Provide all RAC denial reporting and tracking of status of denials to the RAC team

Organize, compile and analyze correspondence to determine action needed regarding disposition of denied, unpaid, underpaid and or overpaid claims. Coordinate with management to identify and correct weaknesses in the Revenue Cycle process that can mitigate future denials. Pursue and participate in education for assigned payor to remain current with changes in the healthcare industry

Perform analysis of adjustments to accounts and determine accuracy. Perform calculations to determine accuracy of payments based on contracts, fee schedules or other payment methodologies. Verify information on explanation of benefits to reprocess claims in a timely manner to receive accurate reimbursement based on contractual guidelines

Utilize extensive knowledge of payor contracts to determine the appropriate reimbursement. Maintain knowledge of general insurance laws, guidelines and contract language, knowledge of Medicare, Medicaid, and all commercial insurance programs, including Medicare HMOs and state programs to include filing deadlines, billing requirements, and reimbursement methods. Utilize critical thinking skills to reconcile accounts in a timely manner

Maintain a fast paced process of requests and acknowledgements for data and correspondence. Identify and correct weaknesses in the process and alert management in the event of potential technical denials due to not meeting date sensitive deadlines. Stay current on trends related to Automated denials by the RAC and MIP by attending conferences, seminars and audio conferences

The above statements are intended to describe the general nature and level of work performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified and employees may be required to perform other duties as assigned.

SKILLS, KNOWLEDGE, AND ABILITIES

Requires excellent verbal, written and interpersonal communication skills.
Ability to assess, evaluate, explain, teach, and problem solve using critical thinking and knowledge of basic office functions.
Knowledge of medical terminology and clinic focused health care
Strong knowledge of the RAC process.
Knowledge of both government and a non-government payer requirements
Demonstrates a basic understanding of hospital insurance contracts to determine if treatment and services are covered by insurance at facility
Demonstrates an independent work initiative, sound judgment and attention to detail and the ability to handle multiple tasks simultaneously
Proficient with standard office equipment and software

MINIMUM REQUIREMENTS

· High School Diploma or GED

· 2 years’ experience in medical billing