The EBO Specialist handles various tasks within the back-end revenue cycle area. Job duties may include reviewing and analyzing accounts to determine correct reimbursement, processing and billing claims, reviewing and resolving credit balances, and interacting with third party payors, patients and clients.
This position requires knowledge of revenue cycle processes and systems and the EBO Specialist frequently interacts with others within the team and must contribute to a positive teamwork environment and promote and champion the culture initiative of the organization.
Duties and Responsibilities:
- Understands revenue cycle processes and how each area contributes to account resolution and patient satisfaction
- Works with various revenue cycle applications and uses time management skills effectively
- Works within payer portals, such as Availity, Navinet, Optum Link, GAMMIS and EServices
- Understands payor contracts and can apply calculations to resolve under/overpayments
- Knowledge of medical terminology such as CPT, HCPCS, APC, ASC, DRG and ICD10
- Understands and comprehends electronic remittance advices (835) and explanation of benefits, and uses this knowledge toward account resolution
- Submits reconsiderations and appeals related to denials using payor documentation and portals
- Interacts with third party payors, patients and clients to resolve account balances by using effective oral and written communication skills
- Processes Initial and corrected claims billing, and understands claim processing procedures
- Understands and resolves 277 claim rejections
- Reviews, researches and resolves credit balances
- Reviews, researches and resolves AR reports when assigned by management
- Uses documented standard work processes in daily work activities
- Performs other duties as assigned
Experience and Requirements:
- Minimum of 7+ years experience in back-end revenue cycle processes within a hospital or physician setting, including insurance follow up, denials management, payment variances, cash applications, credit balance resolution, billing and audit
- Previous Cerner CommunityWorks experience
- Working knowledge and interpretation of payor contracts, federal and state regulations, and payor appeal processes
- Detail and goal-oriented individual who is familiar with productivity standards
- Exceptional time management and organizational skills
- Exceptional verbal and written communication skills
- Analytical and problem-solving skills
- Ability to work independently with minimal supervision
- High speed internet and secure home office space if remote work will be performed
- High school diploma or GED required
- Associates or Bachelor’s degree, a plus
- HFMA Certified Patient Accounts Representative (CPAR), preferred
JTS expects our staff to meet or exceed key performance indicators measuring productivity, quality and service level as defined by Management. JTS staff will actively participate in team initiatives and in team status meetings. JTS staff must demonstrate a positive demeanor (internally and towards the clients), good verbal and written communication skills and must be professional in both appearance and approach. The staff at JTS must exercise the ability to prioritize work, handling daily and multiple tasks to completion within the time allotted, while working as part of a team within a demanding environment. JTS Health Partners recognizes that our RCM/EBO Professionals are our greatest asset and in return for your talents we offer a dynamic work environment, competitive salaries and benefit package.
JTS Health Partners (JTS) is a healthcare management consulting firm focused on enterprise Revenue Cycle Management (RCM), Health Information Management (HIM), Health Information Technology (HIT) and Analytics as a Service (AaaS). JTS offers consulting and operational services that align with performance improvement initiatives of healthcare systems, hospitals and physician practices.
JTS Health Partners is an Equal Opportunity Employer.