The revenue cycle in healthcare encompasses all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.
This process includes everything from patient registration to the final payment of a balance. While some positions may not be necessary for your revenue cycle operation and knowledge and skills might vary depending on the organization, here are some key jobs that you might want to incorporate:
Pre-Service Positions
- Patient Access Representative
- Responsibilities: Patient registration, verifying insurance, collecting co-pays, scheduling appointments.
- Skills: Customer service, data entry, insurance knowledge.
- Front Desk Receptionist
- Responsibilities: Greeting patients, managing check-in/check-out processes, answering phones.
- Skills: Communication, multitasking, organizational skills.
- Medical Scheduler
- Responsibilities: Coordinating patient appointments, managing provider schedules.
- Skills: Organizational skills, familiarity with scheduling software.
- Insurance Verification Specialist
- Responsibilities: Verifying patient insurance coverage, pre-authorization of services.
- Skills: Understanding of insurance policies, detail-oriented.
- Patient Financial Counselor
- Responsibilities: Assisting patients with understanding their bills, setting up payment plans, providing financial assistance information.
- Skills: Communication, empathy, financial knowledge.
Interested in joining our RCM business?
Coding & Charge Entry Positions
- Medical Coder
- Responsibilities: Assigning standardized codes to diagnoses and procedures, ensuring accuracy for billing.
- Skills: Attention to detail, certification of ICD-10, CPT, and HCPCS codes, knowledge of coding guidelines, modifiers and understanding insurance policies.
- Charge Capture Specialist
- Responsibilities: Ensuring all services provided are documented and billed correctly.
- Skills: Data entry, attention to detail, understanding of medical services and billing codes.
Post-Service Positions
- Billing Specialist
- Responsibilities: Preparing and submitting claims to insurance companies, following up on unpaid claims. Could also be responsible for resolving clearinghouse edits.
- Skills: Knowledge of billing processes, insurance guidelines, and coding.
- Denials Management Specialist
- Responsibilities: Handling denied claims, analyzing reasons for denials, working on appeals.
- Skills: Problem-solving, knowledge of insurance processes and policy guidelines, attention to detail.
- Accounts Receivable Specialist
- Responsibilities: Managing patient accounts, following up on overdue payments, setting up payment plans. Work outstanding insurance AR.
- Skills: Customer service, knowledge of accounting principles.
- Patient Collections Specialist
- Responsibilities: Contacting patients and insurance companies to resolve unpaid balances, managing collection accounts.
- Skills: Negotiation, persistence, customer service.
- Revenue Cycle Analyst
- Responsibilities: Analyzing revenue cycle data, identifying trends and areas for improvement.
- Skills: Analytical skills, proficiency with data analysis tools, understanding of revenue cycle metrics.
Management Positions
- Revenue Cycle Manager
- Responsibilities: Overseeing the entire revenue cycle process, managing staff, ensuring compliance with regulations.
- Skills: Leadership, knowledge of revenue cycle processes, problem-solving, coding and insurance guidelines, multitasking
- Compliance Officer
- Responsibilities: Ensuring adherence to healthcare regulations, managing audits, training staff on compliance issues.
- Skills: In-depth knowledge of healthcare laws and regulations, attention to detail.
- Director of Revenue Cycle
- Responsibilities: Strategic planning, policy development, overseeing revenue cycle departments.
- Skills: Leadership, strategic thinking, comprehensive knowledge of the revenue cycle.
Run Your Revenue Cycle with Effective Intelligence
- Effective Intelligence Overview
Effective Intelligence combines Patient Financial Clearance Automation, Medical Billing Workflow Automation, and Real-Time RCM Analytics in a cloud-based platform designed to integration with your current EMR/PM technology to measure the effectiveness of your RCM staff.
Review and assess your practice’s financial status in 5 min or less and know exact where you are losing money and why. Measure the work effort of every revenue cycle employee, incentivize and retain your top performers, and help employees that need improvement.
You can prevent most common denials, rejections and write-offs during the scheduling and pre-registration process in advance of the appointment. Configure checkpoints and use central task management to quickly clear patients and keep your front office staffing needs at a minimum.
As team members log in to the web-based application and record each “touch” of a claim, outcome, and next task, key data points are recorded like who completed the task and when, outcome, task notes, internal / external messages sent, collection success and other data points that feed into our real-time analytics.
