The vision of Clinical Health Network for Transformation (CHN) is to support the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.
CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health equity in our organization.
Reporting directly to the Revenue Cycle Manager, Revenue Cycle AR and Follow-Up Specialist is responsible for managing the accounts receivable process within the revenue cycle. This role involves ensuring timely collection of payments, resolving claim denials, and maintaining accurate financial records. The specialist will work closely with insurance companies, patients, and internal departments to optimize revenue collection and ensure compliance with billing regulations.
Essential Functions
Ability to perform all duties for a Billing Specialist
Handle complex accounts for both follow-up, appeal, and credit balance resolution
Follow up on unpaid claims to collect outstanding balances. Investigate and resolve claim denials by reviewing medical records, coding, and payer contracts
Ability to write and submit escalated appeal letters and represent compelling case to overturn denials with payors, following all billing and compliance regulatory guidelines
Reviewing daily clearinghouse rejections, resolving, and alerting management of any trends in claim rejections
Maintain detailed and accurate patient financial records, documenting all account notes and actions taken
Work with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement
Ability to follow-up on multiple payor types and across multiple states for Commercial, Medicare,
Medicaid, Medicaid Managed Care, Blue Cross, Title X, etc.
Review aged accounts, coordinates and escalates any denial and appeal projects with payors
Achieve established key performance indicators (KPIs) for position
Communicate effectively with insurance companies, patients, and healthcare providers to resolve billing issues and ensure accurate claim submission
Assist Manager to resolve issues and provide support and guidance to the revenue cycle team
Ensure compliance with all CHN and affiliate policies, as well as all state and federal regulations
Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
Provides positive and development feedback and accountability related to practices including, but not limited to, equity
The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at anytime.
Qualifications and Experience (Required)
Bachelor's degree in healthcare administration or equivalent experience
Minimum of 2 years of relevant account receivable experience
Previous experience using ICD-10 Medical Coding and Current Procedural Terminology (CPT)
Knowledge of medical terminology
Strong analytical and problem-solving abilities
Proficiency with Microsoft software (Excel, etc.)
Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment
Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary
Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment
Demonstrated dedication to Planned Parenthood’s mission, vision, and values
Strong interpersonal skills and the ability to build relationships with stakeholders
Excellent time management, and problem-solving skills
Qualifications and Experience (Preferred)
Strong General Technology Skills: proficient utilization of Excel, Word, and Windows
environment, Epic, eCW, NextGen or other practice management systems experience a plus
Medical Billing and Coding certification, Certified Revenue Cycle Representative (CRCR) or other certification a plus
Willingness to travel in accordance with the needs of the position, as outlined in the essential functions. Compliance with all CHN travel policies, including safety guidelines while operating a personal vehicle.
Key Requirements
Commitment to advancing race (+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society
Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions
Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
Strong sense of accountability to equitable practices
Understanding of the impact of identity dynamics on organizational culture
Commitment to CHN and Planned Parenthood’s In This Together service ethos, workplace values, and service standards
Clinical Health Network for Transformation (CHN) is an equal employment opportunity employer. We comply with all applicable laws prohibiting discrimination based on race, color, religion, gender and gender expression/identity, age, ethnicity, national origin, ancestry, physical or mental disability, uniformed service member/veteran status, marital status, medical condition, pregnancy, sexual orientation, citizenship status, genetic information, as well as any other category protected by federal, state, or local. We are committed to building an inclusive workplace that values racial & social justice. We strongly encourage all persons to apply, including members from all racial and ethnic groups and members of the LGBTQIA+ community.
