ACU-Serve Corp

The Revenue Cycle Analyst is responsible for analyzing and managing various aspects of the revenue cycle process, including billing, collections, coding, and reimbursement. This role involves ensuring accurate coding, managing claims, and identifying opportunities to enhance revenue capture. | Candidates should have at least one year of experience in revenue cycle analysis within the healthcare industry, preferably in infusion. A high school diploma or GED is required, with post-secondary education in a medical discipline highly desired. | Job Description Summary: The Revenue Cycle Analyst will play a vital role in optimizing the revenue cycle process.  This position is responsible for analyzing and managing various aspects of the revenue cycle process, including billing, collections, coding, and reimbursement.   The successful candidate will have a keen eye for detail, exceptional analytical skills, and a deep understanding of medical billing and collections.     Qualifications:        * Desired one Year experience in revenue cycle analysis within the healthcare industry, preferably in infusion.  * Minimum of a high school diploma or GED is required.    * Post-Secondary education in a medical discipline highly desired.,  * Knowledge of Windows, Word, and Excel is highly desired. * Excellent telephone and communication skills essential.  * Strong analytical skills and attention to detail * Familiarity with healthcare IT and revenue management software.  * Ability to work independently and part of a team.  * Not required but desired experience with CPR+, Caretend, Weinfuse, HcN360. * The ability to use logic as a problem-solving skill, and able to recognize trends to make decisions to improve business.       Duties and Responsibilities:   * Ensure accurate coding, charge capture, and billing practices in compliance with industry standards (i.e., CPT ICD-10, HIPAA) * Collect data from our Clients daily or weekly, to generate claims using various software platforms.  * Manage and monitor claims to maximize timely and accurate reimbursement, including claim submissions, denial management and appeals.  * Identify opportunities to enhance revenue capture, minimize revenue errors, and reduce bad debt through analysis of key performance indicators. * Analyze payer contracts, fee schedules and reimbursement to ensure proper reimbursement is made on paid claims. * Track claims that are pending due to missing or incomplete documentation (i.e.: DIF, RX, authorization, etc.). * Ensure claims are submitted promptly to insurance companies within their specified filing period.  * Regularly make follow-up calls to insurance providers to check the status of claims not settled within 30 days or their standard processing time.   * Timely submission of appeals to secure correct payment for outstanding claims * Address partial payments and denials promptly while also submitting and following up on secondary claims for resolution.  * Deliver outstanding communication to clients both verbally and in writing. * Recognize and report any issues or patterns to management as necessary. * Work claims rejected in the claim’s clearinghouse and resubmit them as required. * Ensure that notes are recorded within the client’s software platform in a clear, concise, and timely manner. * Additional duties as assigned.

Verify insurance benefits, obtain prior authorizations, follow up on status requests, and manage clinical documentation for biologic drug cases. | High school diploma or GED, 0-1 years experience with authorization processes, knowledge of medical codes and insurance benefits, strong communication and organizational skills. | As the Benefit Verification and Authorization Analyst I should be a highly self-motivated individual with exceptional organizational and communication skills. You will be responsible for daily intake verification of biologic drugs, actioning prior authorization requests, following up on status requests, and obtaining updated clinical documentation for assigned cases. The Analyst I will work to collaborate with other Analysts and bring questions to Analyst II and Supervisor for review. Qualifications: • Must have obtained a High School Diploma or GED • Minimally 0-1 years of experience or able to demonstrate expert knowledge and understanding of authorization processes. • Knowledge of CPT and ICD-10/Procedure Codes, Medical policies, LCD’s and Medical terminology. • The ability to interpret patient benefits to include deductibles, copayments, and coinsurance. • Works efficiently to ensure documentation and notification is processed in a timely manner • Professional communication both internally in work environment and externally (customer facing) • Familiarity with HCPCS, J codes and conversions is a preference • Preferred experience with home infusion, specialty therapy billing practices preferred • Preferred experience dealing with commercial and government payers • Knowledge of Microsoft Tools such as Excel, Word, office 365 experience, is a must • Analytical skills with math and clear penmanship is a must Duties and Responsibilities: • Serve as a liaison between ACU-Serve and our clients ensuring all clinical documentation is obtained to gain procedure authorizations • Work directly with Payers (Insurance) clients to perform insurance benefits verification for infusion services for assigned clients • Performs pre-certification and obtains authorizations and referrals as required by Payer guidelines • Gathers medical documentation to support the Patients' treatments for further review • Follow-up on pending referrals, pre-certifications, and/or pre-determination • Scan and upload documents from insurance providers into electronic records system and work closely with client and billing once approved • Research and follow up on authorization denials