Job Description

Job Location: Spicewood - Austin, TX 78759
Position Type: 40 HRS - 1 FTE
Job Shift: M-F 8A-5PJOB TITLE:        Revenue Cycle Specialist
DEPARTMENT:  Finance

POSITION SUMMARY
The Revenue Cycle Specialist is responsible for managing the revenue cycle processes to ensure timely, accurate, and compliant reimbursement for hospice services, with a primary focus on Medicare Part A billing and collections. This position oversees claims submission, payment posting, accounts receivable follow-up, denial management, and appeals while ensuring compliance with Centers for Medicare & Medicaid Services (CMS) regulations and organizational policies.
WORKING RELATIONSHIPS
REPORTS TO:   Controller
SUPERVISES:   None
INTERPERSONAL RELATIONSHIPS: All comments, actions and behaviors have a direct effect on the public’s perception of Hospice Austin. Interactions with patients, family members, physicians, referral sources, visitors, co-workers, etc. must be in a manner that is courteous, respectful, cooperative and professional. This behavior should promote an atmosphere of teamwork and positive relations.
ESSENTIAL FUNCTIONS
- Manage the complete Medicare Part A revenue cycle, including notice of election processing, billing, payment posting, accounts receivable follow-up, and reimbursement reconciliation.
- File Notices of Election (NOEs/81A) timely and accurately, review the Medicare Common Working File (CWF), and verify Medicare eligibility, certification periods, benefit days, and primary payer status.
- Coordinate monthly billing activities with Nursing, Clinical, and Administrative staff to ensure accurate and timely billing for all payers, with emphasis on Medicare Part A reimbursement.
- Perform pre-billing quality assurance reviews using established month-end accounts receivable checklists to ensure billing accuracy and compliance.
- Generate, review, and submit primary and secondary claims for Medicare Part A and other payers in accordance with CMS billing guidelines.
- Monitor claim status, research claim edits and rejections, resolve billing issues, and resubmit corrected claims to ensure timely reimbursement.
- Utilize Direct Data Entry (DDE), Medicare systems, clearinghouses, and other payer portals to research claim status and resolve outstanding accounts receivable.
- Prepare and process claim corrections, retroactive billing adjustments, reopenings, reconsiderations, and appeals as necessary.
- Run retroactive change reports and generate or adjust claims based on changes affecting reimbursement.
- Post Medicare payments, contractual adjustments, and remittance advice (ERA/EOB) accurately within the patient accounting system, including hospice per diem and consulting physician payments.
- Process consulting physician invoices and ensure accurate billing and payment reconciliation throughout the month.
- Monitor accounts receivable aging reports, investigate outstanding balances, and perform timely follow-up to maximize collections and reduce days in accounts receivable.
- Identify, investigate, and resolve denied, rejected, underpaid, or unpaid claims while documenting all account activity.
- Follow up on all services that have not been billed to ensure complete and timely claim submission.
- Bill charity care accounts in accordance with organizational policies and processes, approve charity write-offs, and bad debt adjustments.
- Verify patient insurance eligibility, benefits, and Medicare entitlement and ensure all required documentation supports medical necessity and billing requirements.
- Ensure compliance with CMS regulations, Medicare Administrative Contractor (MAC) requirements, HIPAA, and organizational policies.
- Maintain current knowledge of Medicare Part A regulations, hospice billing requirements, reimbursement methodologies, and industry best practices.
- Monitor revenue cycle key performance indicators (KPIs), identify reimbursement trends, and recommend process improvements to enhance operational efficiency and reduce denials.
- Maintain complete and accurate patient financial records and supporting documentation in the electronic health record and billing systems.

Qualifications
- High school diploma or equivalent required; Associate degree in healthcare, Business, Accounting, or a related field preferred.
- Minimum of three (3) years of experience in healthcare revenue cycle, medical billing, or patient financial services, with emphasis on Medicare Part A billing.
- Strong knowledge of Medicare Part A reimbursement methodologies, institutional billing, and CMS regulations.
- Experience with UB-04 (CMS-1450) institutional claim submission.
- Knowledge of Medicare Administrative Contractor (MAC) processes, claim corrections, appeals, and denial management.
- Experience using electronic health records (EHR), patient accounting systems, and claims management software.
- Proficiency with Microsoft Office applications, particularly Excel.
- Strong analytical, organizational, and problem-solving skills.
- Excellent verbal and written communication skills.
- Ability to manage multiple priorities while maintaining accuracy and meeting productivity standards.
PREFERRED QUALIFICATIONS:
- Certified Medical Reimbursement Specialist (CMRS), Certified Professional Biller (CPB), or other relevant healthcare revenue cycle certification.
- Experience with inpatient hospital, skilled nursing facility (SNF), rehabilitation, hospice, or home health Medicare billing.
- Experience with revenue cycle reporting, reimbursement analysis, and process improvement initiatives.