Specialist I, ROPS (Lab)

General Purpose of the Job

The ROPS Specialist I (Lab) performs essential duties within various teams of Revenue Operations. This role applies knowledge and skills to complete a wide range of tasks at a level which meets department standards and ensures goals and objectives of Revenue Operations are achieved. Teammates perform routine tasks with some variation from standard processes and are expected to address straightforward issues with moderate supervision.

Essential Duties and Responsibilities

• Generates and submits claims for electronic payers by utilizing the A/R system and clearinghouse to ensure proper and timely submission of all claim files
• Resolves errors associated with claim submission rejections via the appropriate payer by researching and/or calling the payer and facilitating corrections by another department if necessary
• Maintains payer billing and clinic demographic system tables timely and accurately
• Tracks medical record requests, performs periodic billing audits
• Maintains insurance records including patient eligibility and calculation of coordination of benefits related to outpatient kidney dialysis lab testing
• Resolves multiple discrepancies/errors in the A/R system to ensure timely claim submission
• Applies payments and/or denials to the appropriate patient claim accurately based on supporting documentation
• Interprets non-cash denial line items accurately by selecting the closest related denial code in the AR system
• Balances all posted amounts to check and batch amount; troubleshoots as necessary; resolves out-of-balance conditions by posting adjustments and corrections for reconciliation purposes
• Researches difficult Remittance Advices for resolution to avoid posting to the unapplied cash account
• Updates cash batch tracking, prioritizes workload, resolves work queues, and adjusts misapplied payments timely
• Takes appropriate steps to resolve credit balances, including preparing documentation for refund checks, requesting recoupment from the payer, or completing adjustments for false credits
• Evaluates credit balances in the A/R system to determine whether a refund is due or an adjustment is needed
• Documents pertinent information for the refund on the reversal tracking spreadsheet and addresses all returned checks and reprocesses where applicable
• Other duties and responsibilities as assigned

Qualifications

• 0-2 years experience
• Minimum of 6 months medical office or data entry experience preferred
• Must have High School Diploma/GED
• Strong 10 key skills by touch preferred
• Minimum of 50 wpm typing speed
• Knowledge of medical terminology and how to read and locate information on insurance remittance advice or invoices preferred
• Able to work overtime as needed with little to no notice
• Must be fluent in the written and verbal skills necessary to successfully perform the essential functions, duties, and responsibilities of the position