Job Description
POSITION SUMMARY:
The Revenue Cycle Specialist is responsible for the full-cycle medical billing process, including eligibility verification, claims generation, eligibility verification, payment posting, denial resolution and follow-up, and responding to billing inquiries. While each Specialist may have a primary focus area (such as front-end processes like eligibility and claim creation or back-end processes like denials and follow-up), both roles are expected to be cross-trained and capable of performing all core billing functions to ensure operational coverage and flexibility.
Primary Responsibilities:
Billing, Claims Processing, and Compliance
Verify insurance eligibility and hospice benefit coverage at admission and throughout care.
Reconcile charges and coding in the EMR and billing system to ensure accuracy and compliance.
Prepare, review, and submit Notices of Election (NOE) and Notices of Termination/Revocation (NOTR) in alignment with CMS timelines.
Submit timely, accurate claims to Medicare, Medicaid, commercial, and self-pay accounts.
Reconcile nursing home, GIP, and Respite invoices to ensure accurate vendor payments and billing.
Payment Posting, Denial Management Reconciliation
Post Electronic Remittance Advices (ERAs) and manual payments in the billing system.
Maintain the remittance folder and reconcile posted payments with bank deposits and payer documentation.
Identify and follow up on underpayments, overpayments, and discrepancies; initiate appropriate corrective actions.
Review and resolve rejected or denied claims through correction, resubmission, or appeal.
Prepare and submit write-off requests to the Business & Revenue Cycle Manager, including supporting documentation and rationale.
Maintain accurate billing records for compliance with Medicare and Medicaid regulations.
Billing Support and Communication
Respond to internal questions regarding eligibility, payer coverage, and patient accounts.
Address occasional patient inquiries regarding billing or statements, focusing on clarity and empathy in hospice care contexts.
Collaborate with vendors and facilities (e.g., nursing homes) to reconcile room and board charges and ensure accurate third-party billing.
Generate aging reports, denial reports, and reconciliation summaries. Other reports as needed.
Support internal and external audits with timely documentation and claims history
Credentialing & Other Duties
Assist in enrolling new providers with payers and maintaining active status.
Maintain provider access in systems such as Hoku and PECOS to support accurate billing.
Assist in creating and updating internal billing process documentation.
Participate in team meetings to share insights, updates, and process improvements.
Perform other billing-related duties as assigned.
Qualifications and Skill Requirements:
Excellent communication and interpersonal skills
Attention to detail and organizational skills.
Ability to work harmoniously with a broad range of staff, volunteers, and the community as a representative of Navian Hawaii.
Demonstrates good judgment in seeking and accepting guidance, facilitates clear and honest communication with other team members.
Consistently demonstrates ethical conduct and judgment that is in harmony with the mission and values of Navian Hawaii
Experience and Educational Requirements:
High School Diploma or GED equivalent required.
1–3 years of experience in healthcare billing and coding preferred; hospice specific billing is a plus.
Experience in nonprofit healthcare setting is a plus.
Proficient in the use of MS Word, Excel, Outlook, and overall computer skills. GL software knowledge preferred.
Is knowledgeable of and maintains HIPAA standards of privacy and confidentiality.
Working Conditions:
Indoors in an air-conditioned office / work from home
Equipment Used:
Operates phone system, computer (Word, Excel, Microsoft Outlook, EMR Platform, clearinghouse, Bill.com, Cyma Accounting Software and other platforms accordingly), calculator, copier, and facsimile.
Hours:
Generally, Monday through Friday, 8:00am through 4:30pm.
Why Navian Hawaii?
Salary Range:
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