RCM Specialist

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RCM Specialist

This position is responsible for maintaining a timely revenue cycle and ensures accurate payment for goods and services according to contracted rates and/or payor fee schedules. Also responsible for maintaining patient confidentiality and function within the guidelines of HIPAA.

Job Duties:

Accounts Receivable:

• Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites.
• Investigate and resolve customer inquiries regarding charges.
• Monitor patient account details for non-payments, delayed payments, and other irregularities.
• Communicate with customers regarding insurance, payments, and invoices.

Authorization and Confirmation:

• Collaborates with internal & external customers to provide status updates & coordinate appeals on denied authorization.
• Resolves pending revenue by reconciling approved authorizations and pending charges.
• Ensure orders will bill correctly to insurance.

Data Support:

• Responsible for the daily claims submissions/printing for all eligible/ready status claims
• Resolves all claim rejections in a timely manner to guarantee submission within the timely filing requirements of the payers.

Unbilled Revenue:

• Analyze documentation required for billing services and ensure compliance to payer requirements.
• Resolve pending revenue by reconciling received?documentation?and pending charges.
• Requests authorization from state Medicaid programs.
• Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices.
• Completes accurate documentation of authorization request and follow up activities on each account.

Patient Financial Services

• Identify trends and root causes related to inaccurate private pay billing, and report to manager while resolving account errors.
• Investigate escalated customer billing inquiries and take appropriate action to resolve the account.
• Respond to Collection agency regarding patient disputes of balances owed on accounts.

All RCM Specialist responsibilities:

• Educate patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends
• Maintains an extensive knowledge of different types of payer coverage, insurance policies, payer guidelines and payer contracts ensure accurate billing and timely payment is received.
• Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification.
• Performs other related duties as assigned.

Competency, Skills and Abilities:

• Analytical and problem-solving skills with attention to detail.
• Strong verbal and written communication.
• Excellent customer service skills.
• Proficient computer skills and knowledge of Microsoft Office.
• Ability to prioritize and manage multiple tasks.
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.