Revenue Cycle Specialist

COOK INLET TRIBAL COUNCIL, INC.

Job Title:

Department:

Finance

Reports To:

Revenue Cycle Manager

Supervises:

None

FLSA Status:

Non-Exempt

Pay Grade:

Job Type:

Regular, Full-Time

AKBCU: No

ICPA: No

General Functions:

The Revenue Cycle Specialist ensures accurate and timely billing and collections for CITC's healthcare services by managing third-party payor claims, account follow-up activities, and outpatient billing processes. This position requires expert knowledge of Federal and State regulatory requirements, payor contracts, and CITC billing policies to maximize revenue recovery while maintaining compliance. Working in partnership with our people, the Revenue Cycle Specialist helps develop opportunities that fulfill our endless potential by ensuring financial resources are efficiently managed to support CITC's programs and services. The role serves as a subject matter expert in specialized revenue cycle functions and provides cross-functional support as needed.

Duties and Responsibilities:

Review, analyze, and submit claims to third-party payors ensuring accuracy and compliance with Federal and State regulations.
Research, correct, and resubmit unpaid or denied claims while tracking resolution through multiple EHR and billing platforms.
Perform complex account follow-up activities by working aged receivables and utilizing A/R reports in revenue cycle management systems.
Resolve registration and claim information issues by collaborating with clinical and administrative staff to ensure complete documentation.
Interpret explanation of benefits (EOB) to identify denials and underpayments, then negotiate with insurance carriers for proper reimbursement.
Submit third-party payor appeals and reconsideration requests within required timeframes to maximize revenue recovery.
Post payments from third-party payors, Medicaid, and patients while verifying accuracy of payment and adjustment posting.
Verify charge entry accuracy and make corrections as needed to ensure proper billing and reimbursement.
Maintain communication with providers, patients, and insurance representatives regarding account issues and payment status.
Meet department productivity goals and benchmarks while managing multiple tasks, projects, and deadlines simultaneously.
Submit and track resolution of provider queries to ensure complete and accurate documentation for billing purposes.
Protect participant privacy in accordance with CITC policies and HIPAA regulations when handling protected health information.
Assist other staff members to maintain current department workload and provide cross-functional coverage as needed.
Report privacy concerns or policy violations to the designated Privacy Officer without threat of retaliation.
Perform all related duties as needed and assigned.

Job Specifications:

Demonstrated knowledge of medical electronic billing procedures, coding, and revenue cycle processes.
Strong problem-solving and decision-making skills with ability to research and resolve complex billing issues.
Excellent verbal and written communication skills with strong customer service and negotiation abilities.
Proficient computer skills including Microsoft Office applications and ability to navigate multiple EHR and billing platforms.
High degree of accuracy and attention to detail with demonstrated proficiency in data entry.
Knowledge of general accounting principles, medical insurance, and associated Federal and State regulations.
Ability to work independently with minimal supervision while managing multiple priorities under pressure.
Demonstrated knowledge and understanding of the social, health, educational, training, and cultural needs of the Alaska Native and American Indian community.
Ability and willingness to work remotely as needed with appropriate technology and internet connectivity.

Minimum Core Competencies:

CITC Values, Respectful Leadership, Professionalism, Emotional Intelligence, Problem Solving/Critical Thinking, Communication Skills.

Minimum Qualifications:

Continued employment is contingent upon completion of satisfactory state and federal fingerprint criminal background check.
High School Diploma or GED.
Three (3) years of billing revenue cycle experience.
Three (3) years of medical billing experience.

Preferred Qualifications:

Five (5) years of billing revenue cycle experience.
CRCR or CPC certification.
Alaska Behavioral Health billing experience (State Plan and/or 1115 Waiver).
Experience with tribal/IHS billing and reimbursement.

Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

May require prolonged periods of sitting at a desk and consistently working on a computer with repetitive motion.
The need to occasionally move around the office to access filing cabinets, storage cabinets, and office equipment may be necessary.
Must be able to lift up to 25 pounds occasionally by utilizing proper lifting techniques and working in a safe manner.

Disclaimer
The information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job. It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees assigned to this job. Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time. This job description is not an employment agreement or contract.

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