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Catalpa Health
for more information, please call
920.750.7000
Careers
Revenue Cycle Representative
- Job Title
- Revenue Cycle Representative
- Job ID
- 27687470
- Location
- Appleton, WI 54914
- Other Location
- Description
-
Last Updated: November 2022
Revenue Cycle Representative
Department: Administration
Reports To: Revenue Cycle Lead
Direct Reports: No
FLSA Status: Full Time, Non-Exempt
Employment Eligibility: Must be legally authorized to work in the United States without sponsorship
Work Location: Work is performed at the corporate location, with an office setting, indoor and climate-controlled. Periodic remote work is available. Must work in a location within the United States.
Work Hours: Work is done during standard business hours. May require some evening hours.
Compensation: Salary varies based on experience
Benefits Eligible: Yes
Catalpa Health is a pediatric mental health organization that provides pediatric and youth mental health services including psychiatry, mental health therapy and psychological evaluations to children and their families through clinics in Appleton, Oshkosh, and Waupaca. Additionally, mental health therapy services are offered in more than 50 area schools. Founded and managed as a collaboration between healthcare systems Ascension Wisconsin, Children’s Wisconsin, ThedaCare, and our community, Catalpa Health is invested in community partnerships and works with other mental health providers to ensure that all children are receiving the right care at the right time, close to home.ABOUT CATALPA HEALTH
At Catalpa Health, we provide human-centered care to children in need. We put people first—both patients and those who dedicate their lives to delivering care. It's hard work, but we balance it with a workplace that is inclusive, flexible, and friendly.LIFE AT CATALPA
We believe that small things can make a big difference. We help to instill confidence and enable children to transition to adulthood. There are no easy answers. But we can move mountains with dedication, empathy, and authenticity.
At the very core of this vital work are our incredibly talented people. People who listen first, ask hard questions, and make decisions nimbly and autonomously. We encourage our people to take smart risks and embrace possible failures. You can bring your purpose to life through the work that you do, creating an impactful practice and a better world. Here – at Catalpa Health.
The Revenue Cycle Representative reports to the Revenue Cycle Lead. The representative supports the office of the Chief Operating Officer and Financial Leader by ensuring the capture, management and collection of patient service revenue. The revenue cycle begins with patient registration and completes when the patient account is at a zero balance. The representative supports and assists with any and all aspects of this process.OVERVIEW AND RESPONSIBILITIES OF THE ROLE
Responsibilities and Assignments
Key responsibilities or assignments in this role may include:
Billing
• Account adjustments – Use appropriate adjustment codes within identified thresholds when making a financial write off or transfer in Epic.
• Appeals - Draft and submit claim appeals to payors. Document accounts and process appeal correspondences from payer.
• Authorizations –Collaborates with appropriate treatment teams and submits prior authorizations as needed for services. Completes and attaches Epic referral to ensure accurate billing.
• Bankruptcy – Review all notices from the bankruptcy court and make appropriate adjustments, documentation, and statement holds on these accounts. Add accounts to BK work queue. Release hold upon receipt and documentation of the Discharge Notice. May use PACER database in lieu of paperwork.
• Charge Review – Review and resolve charges assigned to the Charge Review work queue including duplicate charges, no charges, and EAP charges. Communicate with providers when coding errors exist.
• Claims - Submit and resubmit claims to payors. Submit corrected claims when appropriate.
• Claim Edits – Review and resolve claims assigned to the Claim Edit work queue.
• Collections – Review and transfer qualified accounts via Epic to our outside collection agency. Notify providers when a current patient account is being sent to collections. Recall qualified accounts via Epic.
• Denials – Resolve denials, troubleshoot denial trends and submit claims projects directly with payor when necessary.
• Financial Assistance – Perform all aspects of Catalpa’s financial assistance program, Catalpa Cares, including creating an Epic Case and Tracker, sending application to guarantor and upon receipt of the completed application enter financial information into Epic. In addition, the rep will notify the guarantor of approval or denial via Epic letter.
• Insurance Verification - Verify patient insurance benefits and eligibility via Epic RTE, online portals or phone.
• Payment Plans – Create payment plans via Epic within established payment plan parameters.
• Refunds – Review and issue patient and insurance payments as appropriate.
Collaboration
• Attend billing meetings with Catalpa’s revenue cycle partner
• Attend education and collaborative meetings as scheduled
Success Criteria:
People who are successful in this job display the following:
- Motivation: Displays passion for children’s mental health and pride in the work they do
- Engagement: Wants to be part of something bigger in the community.
- Integrity: Commits to doing the best job possible. Can be counted on. Takes responsibility for own actions.
- Client Focus: Dedicated to getting to know your client, listening attentively, establishing trust and respect, and understanding their needs and motivations.
- Humility: Seeks, accepts, and applies criticism and feedback. Learns from their mistakes. Is kind and creates a safe environment for others to make mistakes and learn.
- Transparency: Approaches difficult situations and conflicts with courage, empathy and respect. Values open communication and honesty.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Required Education/Experience:
- Associate Degree in Administrative Assistant, Marketing, Business Administration, or related fields or
- 2 + years of recent experience in billing or healthcare
- Any appropriate combination of education and experience as determined by management.
Certifications & Licenses/Experience:
Name Required/Preferred Certified Revenue Cycle Representative Preferred
Certified Billing Specialist Preferred
Equal opportunity
The world’s most talented professionals come from every background. Catalpa Health cultivates a diverse workforce and inclusive workplace to enhance the depth, innovation, and quality of the services we offer.
Catalpa Health is an equal employment opportunity employer and provides equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.
Catalpa Health will provide reasonable accommodations for qualified individuals with disabilities. All qualified candidates are encouraged to apply.
