Job Functions, Duties, Responsibilities and Position Qualifications:

Position Summary:

The purpose of the Revenue Cycle Specialist is to ensure that all aspects of the Revenue Cycle process for molecular and genetic testing claims process within standard SOP and Compliance guidelines. Monitor collections to ensure all accounts receivable expectations met within department's set guidelines and contracts.

This will be a full time position supporting the Sonic Healthcare USA ThyroSeq Laboratory (760 Westchester Avenue, Rye Brook, NY 10573).

Job Responsibilities:

• Pre-screen each molecular test that currently requires prior authorization (PA) in the organization's PA system; following established SOP and workflows.
• Initiate PA request for specific payer following processes and workflows established by the department.
• Initiate Referring PA request with appropriate physician and follow-up until PA obtained.
• Follow-up on direct PA request with payers to ensure PA obtained timely.
• Research and respond to all complex matters received through billing correspondence and insurance carrier denials.
• Review insurance remittances for allowances and rejections, and respond with corrective action using industry modifiers, MUE edits, and medical necessity denials.
• Prepare correspondence and attach proper documentation for the appeals process or resubmit corrected claims using clearinghouse utility within the appropriate time limit.
• Identify payer trends and work with insurance/provider representative or management to bring to resolution.
• Handle all inbound calls regarding patient phone inquiries concerning balances, payment plans, credit card payments, patient pricing, updating patient demographics, re-billing insurance companies and general customer concerns.
• Access to payer web portals to review claim status, check eligibility and benefit coverage.
• Evaluate and respond to all aspects of written billing inquiries from patient or their legal representative or clients including but not limited to billing insurances, updating invoices, troubleshooting billing issues and complex customer complaints.
• Process payments, adjustments, refunds, transfer bills and mail returns.
• Review special circumstances including patients seeking patient hardship, bankruptcy and collection agency referrals.
• Ensure all credit balances are resolved and refunds generated in a timely manner.
• Maintain and update internal insurance database including timely filing limits, appeal rights for billing department reference and instruction.
• Support sales team and request for information as it pertains to patient billing.

Job Qualifications:

• High School diploma or equivalent required; college degree preferred.
• At least three (3) years' experience in healthcare accounts receivable environment preferably in a laboratory setting; knowledge of medical terminology, billing practices and appeals experience a plus.

Scheduled Weekly Hours:

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Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.