JOB OVERVIEW: ( Capitation Billing Workflow)This position is responsible for the assessment and analysis of diverse data related to the revenue cycle, maintenance of the core files of the practice management system, synchronization of EmblemHealth and other capitated membership rosters with patient insurance records, and supports all processes in the physician billing revenue cycle.ESSENTIAL FUNCTIONS:1.Reviews revenue cycle patterns by procedure, diagnosis, payment, contractual adjustment, denial, insurance type and insurance groupings. Analyzes and reports variances. 2.Researches and challenges questionable determinations, and identifies work-flow opportunities to prevent or minimize claim rejections and denials at payer level.3.Identifies revenue cycle problems and opportunities, and works to provide effective, practical solutions. 4.Works with cross functional departments to research and resolve issues. 5.Concisely communicates findings and recommendations, both verbally and in writing. 6.Keeps appraised of rules and regulations affecting reimbursement and stays current through appropriate journals and personal contacts of such developments in the industry as may increase the effectiveness of operations. 7.Conforms to all applicable HIPAA and Billing Compliance policies and guidelines. 8.Performs other duties and responsibilities as assigned by the Revenue Cycle Manager SKILLS REQUIRED:1.Must possess a strong understanding of the healthcare revenue cycle. 2.Must demonstrate investigative, analytical, and critical thinking skills.3.Must have knowledge of electronic billing systems for front end and back end functions and show willingness to learn new systems, applications and programs4.Ability to work independently, follow through and handle multiple tasks/special projects simultaneously. 5.Must be able to function in a complex, agile, fast-moving workplace and adapt to a changing environment. 6.Must have superior collaboration and interpersonal communication skills, flexibility and responsiveness. 7.Must have excellent documentation, communication and presentation skills. 8.Must be a motivated individual with a positive and exceptional work ethic with the ability to interact positively and constructively with employees, professional clinical staff and senior management.EXPERIENCE REQUIRED:1.Four years experience in a health care revenue cycle setting with working knowledge of large multi-specialty capitated group practice environment.2.Practical experience of services related to insurance verification and management of patient information. 3.Practical, hands on experience with CMS-1500 electronic claim billing. 4.Knowledge of payer reimbursement / payment policies, medical terminology, and coding (ICD-9, CPT, etc).5.Computer experience (MS Word, Excel, Access, and Outlook). 6.Experience and proficiency with practice management and billing software.EDUCATION REQUIREMENTS:1.Bachelors Degree in health or other related field, or some related college or equivalent advanced knowledge of the health care industry. 2.Advanced certifications preferred (e.g. Registered Health Information Technician, RHIT).3.Equivalent combination of education and experience may be considered.