Revenue Cycle Specialist Resume Sample
Abbey Maggio
734 Reinger Island,
Dallas,
TX
+1 (555) 222 0869
Work Experience
Revenue Cycle Specialist
10/2016
-
PRESENT
Los Angeles, CA
- College level courses in finance, business or health insurance
- Works collaboratively with the EMR Specialists to ensure consistent and coherent processes that involve charge capture within the EMR and the impact to charges transferring to the practice management system. Assists (along with the CBO) with resolving suspended charges when caused by ‘front-end’ or EMR related issues
- Ensures compliance with payer regulations affecting registration, scheduling, financial clearance and their impact on reimbursement
- Effectively interprets new or updated payer information. Suggests areas where staff re~education is needed. Coordinates appropriate training material with QA and training design staff
- Acts as the liaison between third party payers and SRCO Patient Access teams. Serves as subject matter expert for compliance issues and questions received from Access Operations staff and performs necessary research and analysis to provide accurate responses and recommendations
- Develop, implement and manage Regulatory Compliance processes/updates
- Travel required < 25%
- Frequent use of computer, keyboard, copy, fax and scanner machine and the phone
Revenue Cycle Specialist A / R Follow Up
06/2010
-
05/2016
Chicago, IL
- Frequent (34-66% of the day) - sitting, standing, walking, reaching with hands and arms, flexing/extension of wrist use, grasping and fine manipulation, talking and hearing
- Occasionally (11-33% of the day)-bending, climbing, kneeling, reaching at or above shoulders
- Infrequent (1-11% of the day) - crawling or crouching
- Healthcare Provider work experience
- Experience as solution architect or consultant driving Financial/Business (Revenue Cycle) solutions in Healthcare Provider market
- Knowledge of coding, billing and the Cleveland Clinic revenue cycle
- Demonstrated knowledge of medical terminology and organization of the medical record coding systems
- Computer literacy and Microsoft office products with emphasis on spreadsheets and word processing applications
Revenue Cycle Management Specialist
11/2006
-
12/2009
Chicago, IL
- Medical terminology and anatomy/physiology courses
- Valid Driver’s License
- Payment Postings and Reconciliations. Posts payments to collection accounts, reconciles with posted bank transactions, works with AP department to have refund issued when needed, reconciles monthly bank statements with cash posting database. Posts adjustment transactions to collection system as well as client’s system. Systems Capability
- Payment Postings and Reconciliations. Post payments to collection accounts, reconciles with posted bank transactions, works with AP department to have refund issued when needed, reconciles monthly bank statements with cash posting database. Posts adjustment transactions to collection system as well as client’s system
- Printing, scanning and copying documents ie: Medical records, IZ’s, invoices, letters
- Researches, identifies and corrects pharmacy billing errors
- Knowledge of procedural and ICD10 coding required
- Basic knowledge of medical billing terminology required
- Monitor and Send Claim Files and Paper Claims to Commercial, Medicare and Medicaid
Education
Grand Valley State University
2001 - 2006
Bachelor's Degree in Health Information Management
Professional Skills
- Strong organizational, quantitative skills and analytical skills
- O Strong organizational, quantitative skills and analytical skills
- Organized work habits, accuracy, and proven attention to detail, with strong analytical skills
- Excellent analytical, problem solving, and interpersonal and communication skills
- Work well with others - strong teamwork skills
- Proven data entry skills required
- Strong research and negotiation skills required
How to write Revenue Cycle Specialist Resume
Revenue Cycle Specialist role is responsible for analytical, software, research, finance, training, database, compensation, design, insurance, travel.
To write great resume for revenue cycle specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Revenue Cycle Specialist Resume
The section contact information is important in your revenue cycle specialist resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Revenue Cycle Specialist Resume
The section work experience is an essential part of your revenue cycle specialist resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous revenue cycle specialist responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular revenue cycle specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Revenue Cycle Specialist resume experience can include:
- Present findings and discuss issues with providers effectively
- Moderate to advanced keyboard skills with high accuracy rate
- Demonstrated accuracy with a strong attention to detail
- Excellent work ethic and ability to prioritize tasks
- Experience working the full cycle billing process including but not limited to charge entry, refunds, AR, denial & appeal process
- Strong understanding of various insurance carriers, including Medicare, private HMOs, and PPOs
Education on a Revenue Cycle Specialist Resume
Make sure to make education a priority on your revenue cycle specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your revenue cycle specialist experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Revenue Cycle Specialist Resume
When listing skills on your revenue cycle specialist resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical revenue cycle specialist skills:
- Strong organization skills including ability to prioritize and meet deadlines
- Demonstrated ability to work effectively in a collaborative manner with all departmental faculty and staff, as well as other institutional representatives
- Outstanding communication, organizational and problem solving skills
- Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues
- High level problem solving and analytical skills are required
- Moderate to advanced computer skills, including Microsoft Windows programs
List of Typical Experience For a Revenue Cycle Specialist Resume
1
Experience For Revenue Cycle Specialist A / R Follow Up Resume
- Answer provider, submitter, and client questions regarding claims and claims related issues
- Reviews various reports and makes recommendations to resolve outstanding patient responsibility
- Assists in training current and new employees on the use of systems and departmental policies and procedures
- Attends workshops and seminars to keeps abreast of billing policies and procedures
- Monitor and work Rejections from 277 files
- Monitor and work denials from 835 files
2
Experience For Senior Revenue Cycle Specialist Resume
- Post payments manually when required
- Process QA and mail statements
- Perform Quality Assurance Audits
- Correct and resubmit rejected, no response and denied claims
- Accounts Receivable follow up
- Receive and import weekly electronic client service data files from multiple locations
- Upload and EDI 999, 277 and 835 files from multiple sources
3
Experience For Revenue Cycle Management Specialist Resume
- Work with providers to correct and resubmit rejected and denied claims
- Provide direction and support across the Revenue Cycle Management team
- Represent the department as a subject matter expert and provide input to department and cross-functional meetings
- Maintain daily, positive communication and collaboration with other departments
- Maintain up to date awareness of payer changes
- Identify trends and opportunities in various processes – including data and procedures – and elevate those, along with recommended solutions, to the management team
- Inbound/Outbound calls from insurance companies and patients to collect outstanding funds
4
Experience For Revenue Cycle Research Specialist Resume
- Works individual portfolio of accounts from billing/collection system
- Work various reports to assist in collection of cash and revenue
- Actively participates in Greenway Revenue Services (GRS) sales at the request of a GRS Consultant including pre-sale needs, pulling and analyzing 3 years of a practice’s financial data, completing a trending analysis, development of return on investment details, and follow-up activities as needed to progress the sales cycle
- Serves as the financial analyst for Greenway Revenue Services opportunities by identifying and analyzing aging by service date, procedure code productivity, annual charges, adjustments, revenue, and denials analysis
- Collaborates with GRS Consultants, IT, and Sales Operations to improve work queues and automate some of the financial reporting
- Reports activity levels for financial reports and trending analyses completed
5
Experience For Revenue Cycle Integrity Specialist Resume
- Follow all Medicare, Medicaid, HIPAA, and Private Insurance regulations
- Claim submission and resolution
- Denials, appeals, and reimbursements
- Documentation of activities with accuracy
- Assesses insurance reimbursement for individual supplies to ensure maximum reimbursement
- Researches and follow up on all correspondence associated with assigned accounts
- Initiates appeals and ensures all required documentation is submitted in the appeals process
6
Experience For Revenue Cycle Specialist Operational Staffing Pool Resume
- Researches all denials and follow up as necessary
- Analyzes and correct accounts receivable problems
- Self-directed with the ability to work with little or no supervision
- Monitor and Send Claim Files, corrected claims and Paper Claims to Commercial insurance and Medicare
- Support clients on the daily operation of the Medicare Part D claiming application. This includes, but is not limited to: updating the NDC maintenance, AR posting, claim reversals, PDP rejections
- Reviews accounts receivable for discrepancies
- Develops work schedules with the supervisor for aggressive account follow-up and resolution
7
Experience For Healthcare Financial Applications \ Revenue Cycle Solution Specialist Flexible Locations Resume
- Performs extensive follow-up to investigate and resolve payment denial trends
- Utilizes the practice management system to sort, filter, summarize and identify various account receivable trends to solicit payments from insurance companies and patients
- Monitors payment patterns and alerts manager to deviations
- Assists patients in appealing denied claims. Prepares letters of appeal to insurance carriers for claims that were not paid or paid at the incorrect rate. Answers inquiries from patients and insurance companies regarding unpaid physician charges
- When necessary resolves charge review, registration and claim edits within the practice management billing system to ensure successful claim submission
- Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors
- Generates reports for analysis
- Reviews and submits refund and write-off requests. Approves and performs write-offs as requested and as necessary
8
Experience For Terrain Specialist, Revenue Cycle Resume
- Under direction, distributes work assignments to staff
- Maintains CDM (Charge Description Master) and/or other pertinent regulations and policies, ensuring all data elements are accurate and comply with all payor and regulatory requirements
- Resolves issues that arise from information submitted and revenue cycle issues
- Provides validation reviews, audits, documentation and training for the area of knowledge, sharing information with Finance, Medical Records and other revenue producing areas or departments
- Reviews, investigates and resolves outstanding claims in coordination with cross-divisional teams and/or vendors to obtain the best financial results on behalf of the company
- Advanced Knowledge of Excel -- Functions, Formulas, Pivot Tables, etc. - Required
- Payment Postings and Reconciliations Post payments to collection accounts, reconciles with posted bank transactions, works with AP department to have refund issued when needed, reconciles monthly bank statements with cash posting database. Posts adjustment transactions to collection system as well as client's system
9
Experience For Revenue Cycle Cash Posting Specialist Resume
- Cash Application Performs cash application functions and processes relevant to the Corporate and client requirements in a manner that meets or exceeds key performance criteria
- Systems Capability Access and understand necessary information of the various online systems, understanding the systems process in determining how a claim has been paid in order to accurately apply payments and adjustments and assists in determining the adjudication of a refund
- Research and Resolution Researches and accurately distributes payments with no apparent invoice number, or date-of-service. Researches and determines the correct claim for the payment if there is a valid patient/date of services and accurately applying payment to correct claim
- Ensures Compliance Maintains thorough and detailed knowledge of compliance and recovery laws regarding processing and recoupment to ensure compliance with state laws regarding all cash processes as evident through the collection cycle
- Prioritize activities to work overturns in a timely manner to alleviate untimely filings
- Experience with hospital Payor contracts
10
Experience For Revenue Cycle Systems Optimization Specialist Resume
- Verify and correct all pertinent claim form information: date spans, HPCPC codes, pricing, modifiers
- Resolves EDI rejections in a timely fashion to assure that claims are being processed to the payer
- Review all unbilled services to ensure timely submission of all claims
- Review, prepare and submits timely, accurate claims to payers for products and services provided
- Resolves ZIRMED front end rejections
- F/U and obtain all expired documentation and authorizations
- Perform A/R follow up on all unresolved receivables
- Identify bad debt write-offs and A/R adjustements
List of Typical Skills For a Revenue Cycle Specialist Resume
1
Skills For Revenue Cycle Specialist A / R Follow Up Resume
- Advanced knowledge of revenue cycle operations Requires good communication skills, both written and verbal
- Demonstrates overall knowledge of claims processing for various insurances, including private and governed
- 0 – 1 year’s related experience, preferably in a medical setting with insurance billing
- Experience in communicating with all levels and handling customer interaction
- Strong background working with all insurances
- Experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center
- Experience working with a medical office/hospital accounts receivable system
- Shift focus as necessary when priorities change without losing sight of original assignments
- Billing experience in the healthcare industry
2
Skills For Senior Revenue Cycle Specialist Resume
- Typical physical demands involve prolonged sitting and dexterity to accurately operate a data entry/PC keyboard
- Credit and/or collection experience in a large volume healthcare setting
- Patient access experience in a pediatric hospital/clinic setting
- Recent medical billing/collections experience required
- Demonstrated understanding of medical terminology required
- Experience performing high volume in person and phone patient customer service in a fast-paced environment
3
Skills For Revenue Cycle Management Specialist Resume
- Excellent communication; teamwork; detailed-oriented
- Demonstrates the ability to maintain the confidentiality of all records. SHMG
- Up to 1 year of relevant experience
- Experience in MS Office products, particularly excel
- Understanding of CPTs, HCPCS, APCs, DRGs and OPPS required
- Posting payments and / or adjustments to individual accounts
- Knowledge of medical billing/coding, front-office, physician practice management and healthcare business processes
- Monitors overall medical billing operations, including
- Assist the RCA with obtaining fee schedules from client and monitoring insurance payments in order to ensure adjudication is complete
4
Skills For Revenue Cycle Research Specialist Resume
- Reviews and interprets various regulatory billing and coding updates, to remain compliant and accurate to minimize mis-billings
- Provides training and mentorship to specific revenue producing departments
- Third party payers protocols CPT/ICD coding
- Baylor College of Medicine confidentiality standards CPT/ICD coding
- Baylor College of Medicine confidentiality standards CPT/ICD coding Baylor College of Medicine policy and procedures
- Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance
- Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment
5
Skills For Revenue Cycle Integrity Specialist Resume
- Contacts patients and guarantors to secure necessary billing information
- Knowledge of CPT4 and ICD9 coding
- Comprehensive knowledge of ICD-10, CPT, and HCPCS coding
- Ensure accurate claim submission and perform account monitoring
- Knowledge of Joint Commission/DHEC standards related to ICD-10/CPT coding guidelines
- Monitor, review and work outstanding AR
- Answer provider, submitter, client questions regarding claims and claims related issues
- Maintain understanding of policies and procedures of the entire Revenue Cycle
6
Skills For Revenue Cycle Specialist Operational Staffing Pool Resume
- Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds
- Reduces delinquent accounts and achieving maximum collections from all sources
- Achieves productivity goals based on accounts touched, dollars collected, and aging period
- Post electronic and manual cash receipts; assisting with the maintenance of applicable reports as necessary
- Monitor outstanding A/R balances for determination of next steps in the escalation process
- Initiate write off and adjustment requests for approval and processing
- Knowledge of CPT, HCPCS, and ICD10 coding required
7
Skills For Healthcare Financial Applications \ Revenue Cycle Solution Specialist Flexible Locations Resume
- Knowledge working with electronic health records (EHR/EMR) or healthcare-related computer systems
- Represents Greenway Health in regional/national trade-shows through exhibit demonstrations and/or speaking opportunities
- Represents Greenway Health in regional/national trade shows through exhibit demonstrations and/or speaking opportunities
- Revenue Cycle Specialist is responsible for obtaining insurance verification, precertification, and authorization via phone and insurance payer portals
- Commercial insurance and managed care insurance terminology Microsoft Office Applications (specifically MS Word and MS Excel)
- Proficient knowledge in Epic Medicare & Texas Medicaid rules and regulations
- Managed care contractual agreements
8
Skills For Terrain Specialist, Revenue Cycle Resume
- Commercial insurance and managed care insurance terminology
- NT Windows Microsoft Office Applications (specifically MS Word and MS Excel)
- Proficient knowledge in IDX Medicare & Texas Medicaid rules and regulations Managed care contractual agreements
- Third party payers protocols
- Baylor College of Medicine policy and procedures
- Proficient knowledge in Medicare & Texas Medicaid rules and regulations
- Commercial insurance and managed care insurance terminology NT Windows Microsoft Office Applications (specifically MS Word and MS Excel)
- Proficient knowledge in Epic
9
Skills For Revenue Cycle Cash Posting Specialist Resume
- Medicare & Texas Medicaid rules and regulations
- Managed care contractual agreements third party payers protocols
- Denial Resolution: researching, resolving, and resubmitting denied claims; taking timely and routine action to collect unpaid claims; and interpreting various forms of explanations of benefits (EOBs) from insurance carriers
- Customer Service: providing quality assistance to Stamford Health Medical Group’s (SHMG) patients to resolve any and all billing-related questions; and ensuring proper demographic and insurance information for those patients served
- Cash Applications: entering patient and insurance payments, contractual allowances, denials, correspondence, and other adjustments into the medical group’s practice management system; balancing and reconciling posting batches; and participating in month-end close
10
Skills For Revenue Cycle Systems Optimization Specialist Resume
- Responds to requests from management, staff, or physicians in a timely and appropriate manner
- Maintains patient and physician confidentiality and professionalism at all times
- Follows department policies and procedures to ensure accurate and timely claim resolution
- Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered
- Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements
- Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims
List of Typical Responsibilities For a Revenue Cycle Specialist Resume
1
Responsibilities For Revenue Cycle Specialist A / R Follow Up Resume
- Ensure effective flow of demographic, charge and payment information
- Previous healthcare claims collection experience
- Experience and competency in customer relations in a professional environment
- Experience in patient registration systems
- Experience with insurance carriers or third party administrators
- Extensive knowledge of charging, payment and reimbursement methodology is required
- Analyze and interpret denial trends and take appropriate action towards denial resolution
- Handle all assigned tasks and/or projects concurrently with minimal supervision
2
Responsibilities For Senior Revenue Cycle Specialist Resume
- Interact professionally and effectively with internal stake holders, third party payers, physicians and staff members for all departments within and outside the organization
- Communicate trends and escalations to the appropriate stake holders
- Identify and pursue opportunities for improvements in denial performance
- Research denial rejections included in EOBs for resolution and feedback
- Categorize denials to through Mede Analytics software
- Knowledge of patient confidentiality and HIPAA regulations
- Revenue Cycle Specialist is responsible for full cycle medical insurance collections for multispecialty physician and hospital services
- Experience required working in a healthcare (professional) billing, health insurance or equivalent operations work environment. Work experience in a client facing position, project management experience and/or customer service highly desirable
3
Responsibilities For Revenue Cycle Management Specialist Resume
- Knowledge: Healthcare (professional) billing, broad knowledge of CPT/ICD-10 coding, claim submission requirements and other related industry terminology and practical use. Knowledge of registration data requirements and health plan payors Thorough understanding of the revenue cycle and how the various components work together
- Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up
- Execute tasks within a tight deadline
- Properly execute tasks outlined in a process and escalate issues/problems in a timely manner
- Understand industry standards such as 837, 999, 277 and 835 files and rejection and denial management
- Work independently and as a part of a team in a deliverable-focused professional environment
- Knowledge of insurance industry and third party payer processes
- Exceptional written, verbal and interpersonal communications
4
Responsibilities For Revenue Cycle Research Specialist Resume
- Assist with the preparation of denial appeals packet and distribution of patient statements
- Work under stress and to meet imposed deadlines
- Demonstrated ability to use PCs, Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required
- Physician A/R experience required (HCFA)
- Treat confidential information with utmost discretion
5
Responsibilities For Revenue Cycle Integrity Specialist Resume
- Advanced knowledge level of Credit and Collections
- Work in a stressful environment and tactfully handle sensitive issues; ability to present a calm, professional manner and to tolerate a wide range of working conditions and personalities; ability to multitask; ability to maintain a sense of order in a busy environment; ability to provide good internal and external customer relations
- Understands the impact of patient registration on the financial revenue cycle
- Advanced knowledge of revenue cycle operations
- Progressive experience within a large hospital or integrated healthcare delivery system, including extensive experience in: hospital finance and reimbursement, accounts receivable, AR systems management, AR systems implementation, government billing and follow up, and payment provisions for Medicare and Medicaid
- Travel required to other facilities within the system.
- Knowledge of Medicare/Medicaid Accounts
6
Responsibilities For Revenue Cycle Specialist Operational Staffing Pool Resume
- Learn and pick up on new concepts quickly
- Work as a part of a team is essential
- Speak English and be understood
- Work in fast paced, high stress environment and meet deadlines
- Work with ancillary department managers and other managers within Advocate system
- Experience of ICD-10-CM and CPT-4 coding (or other applicable successor coding systems) in a multi-specialty physician or Outpatient facility environment
- Documents accounts with clear and concise verbiage in accordance with departmental procedures
7
Responsibilities For Healthcare Financial Applications \ Revenue Cycle Solution Specialist Flexible Locations Resume
- Reviews and responds to correspondence and inquiries received
- Meets and exceeds team productivity and quality standards
- Detailed claims research
- Answer claims calls
- 10 key proficiency
- Same as competent
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