Specialist I, ROPS (Lab)

About the Role

The ROPS Specialist I (Lab) performs essential duties within various teams of Revenue Operations, applying knowledge and skills to complete a wide range of tasks. This role is expected to address straightforward issues with moderate supervision, manage time effectively, develop skills and knowledge, and generate creative solutions. Building rapport with teammates and fostering positive working relationships is expected. This position reports to the Supervisor Revenue Operations (Lab).

Key Responsibilities

• Generates and submits claims for electronic payers by utilizing the A/R system and clearinghouse.
• Resolves errors associated with claim submission rejections by researching and/or contacting the payer.
• Maintains payer billing and clinic demographic system tables timely and accurately.
• Tracks medical record requests and performs periodic billing audits.
• Maintains insurance records, including patient eligibility and the calculation of coordination of benefits for outpatient kidney dialysis lab testing.
• Utilizes patient insurance information provided by DKC ROPS, facilities, and ancillary means to complete the registration process.
• Resolves multiple discrepancies/errors in the A/R system to ensure timely claim submission.
• Applies payments and/or denials to the appropriate patient claim accurately based on supporting documentation.
• Interprets non-cash denial line items accurately by selecting the closest related denial code in the AR system.
• Posts unidentified items to unapplied cash when all other efforts are exhausted and continues to seek resolution.
• Performs adjustments within established department timeframes.
• Balances all posted amounts to check and batch amounts, troubleshooting and resolving any out-of-balance conditions.
• Researches difficult Remittance Advices for resolution to avoid posting to the unapplied cash account.
• Communicates with the insurance company and collections team for resolution assistance.
• Updates cash batch tracking, prioritizes workload, resolves work queues, and adjusts misapplied payments timely.
• Takes appropriate steps to resolve credit balances, including preparing documentation for refunds, requesting recoupment from the payer, or completing an adjustment for false credits.
• Evaluates credit balances in the A/R system to determine if a refund or adjustment is needed.
• Documents pertinent information for refunds on the reversal tracking spreadsheet.
• Addresses all returned checks and reprocesses where applicable.
• Other duties and responsibilities as assigned.

Requirements & Tech Stack

• High School Diploma/GED
• Minimum of 6 months medical office or data entry experience (preferred)
• 10 key skills by touch (preferred)
• Minimum of 50 wpm typing speed
• Knowledge of medical terminology (preferred)
• Knowledge of how to read and locate information on insurance remittance advice or invoices (preferred)
• Ability to work overtime as needed with little to no notice (Nights/Weekends)
• Fluent in written and verbal skills necessary to perform essential functions.

Qualifications

• 0-2 years experience