Manager of Revenue Cycle Services, Lexington MA

Reporting to the Vice President of Revenue Cycle Operations, the Manager, of Revenue Cycle Services is accountable for managing a team of liaisons and also maintaining an ongoing commitment to deliver excellence in client services.

Key responsibilities:

  • 3 + years management experience with Revenue Cycle Services
  • Expertise in the area of Workers Compensation and Automobile Accident claims for states PROMEDICAL is doing business in
  • A passion and ability to solve challenging problems and deliver client solutions
  • Lead liaison team members and activities between PROMEDICAL and clients to ensure new claims are being directed correctly to the responsible parties, and payment information is provided accurately and consistently
  • Perform client account reconciliations, asses’ outcomes, and produce resulting discrepancies
  • Complete reports on status of tasks and prepare associated summaries
  • Review the accuracy of our clients’ reports and PROMEDICAL Revenue Cycle Service audits; then report any errors or inaccuracies to the appropriate person
  • Assist Vice President of Revenue Cycle Services in verifying client report data is complete and accurate
  • Schedule client Audits and Reconciliations on a regular basis to ensure that our system and the clients’ systems are agreeable
  • Travel to client sites for quarterly visits to discuss open issues, and maintain client satisfaction
  • Oversee and continuously review the process for dealing with client credit balances
  • Provide timely response to all inquiries including: specific accounts, patients, employers, attorneys and insurance companies
  • Develop new or current employees reporting to you and ensure they have the tools to get their job done effectively
  • Consistently change strategies within the database system
  • Research claim information on-line and enter new data into existing claim system as information is received with goals of accuracy
  • Record client inquiries on specific accounts and capture responses in database system
  • Implement and review productivity, quality metrics and incentive programs designed to minimize costs and enhance efficiency
  • Lead change with regard to existing programs and processes
  • Establishes client/project goals, milestones, and procedures
  • Attend meetings of hospital finance groups to further develop relationships with the industry

Qualifications include:

  • Advanced knowledge of 3rd party billing in MVA and Worker’s Compensation and revenue cycle business practices
  • Manage, motivate and lead direct reports to drive for results to reach best client outcomes
  • Exceptional organizational skills and flexibility to handle multiple tasks to meet deadlines
  • Strong attention to detail, accuracy and quality while maintaining confidential information
  • Sharp analytical skills and ability to work on multiple client priorities, simultaneously
  • Excellent written, verbal communication and interpersonal skills with liaison’s and clients
  • Proficient in Microsoft Office products Word, Excel, PowerPoint with a high level of computer and technical skills and the ability to learns new programs quickly
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Complex Claims Follow up Analyst – Lexington, MA

The Complex Claims Follow up Analyst working under the Complex Claims Manager is responsible for billing, review, follow up and collection of accounts for third party liability insurance payors, including Auto Insurance coverage, Worker’s Compensation and the Federal Government.

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Claims Follow up Analyst – Lexington, MA

The Claims Follow up Analyst is responsible for the in-depth follow-up of unpaid or denied workers compensation & motor vehicle claims. They will interact with applicable insurance carriers, attorneys, patients and employers with the ultimate goal of liquidating claims in a timely manner. Analysts utilize on-line tools, system strategies, as well as actively communicate over the phone or via email. Analysts will ensure that claims are being billed correctly and that insurance carriers have the necessary information to adjudicate. A healthcare revenue cycle background in medical billing or insurance claim processing is a must and should be comfortable on the phone speaking to carriers, attorneys, patients and employers.

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Claims Validation Specialist – Lexington, MA

The Claims Validation Specialist, a detail-oriented individual who will take full ownership of the position.  Candidates must possess outstanding organizational skills, ability to stay on task with minimal supervision and adapt in a constantly changing environment.

  • Manage both inbound and outbound calls efficiently and effectively by gathering claim information from patients, employers, insurers and others outside firms
  • Verify information, receipt of insurance claim and bill review packages
  • Manage workflow, processing, document specifications for our document management system
  • Review and correct any claim level system holds to prevent rejections
  • Complete all processing and sending of claim files
  • Navigate online systems to perform accurate and timely data entry
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