The Revenue Cycle Management (RCM) Specialist is responsible for timely submission of claims to insurance companies from a wide variety of medical providers and facilities and timely addresses denials. They will monitor, follow-up, and ensure that payments for medical services are received timely and paid in full. The RCM Specialist may function as an intermediary between healthcare providers, clients, patients, and health insurance companies.

ESSENTIAL RESPONSIBILITIES

· Review client accounts for accuracy and completeness. Obtain missing information and submit claims to insurance companies and other payer sources for payment.

· Identify insurance company or correct guarantor (client) to be billed; identify and bill primary, secondary, or tertiary insurances.

· Utilize a combination of client electronic health record and paper records to assist with billing and collections. Maintain accurate and legally compliant health record.

· Review insurance payments for accuracy and compliance with contract discounts.

· Review denials or partially paid claims and work with involved parties to resolve discrepancies.

· Manage assigned accounts ensuring outstanding/pending claims are paid in a timely manner and contact appropriate parties to collect payment.

· Communicate with health care providers, patients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.

· Consult supervisor, team members, and appropriate resources to solve billing and collection questions and issues.

· Maintain work operations and quality by following standards, policies, and procedures; escalate compliance issues to Supervisor.

· Prepare reports and forms as directed and in accordance with established policies.

· Perform other related duties and/or projects as assigned

QUALIFICATIONS

· High school diploma or equivalent. Bachelor’s Degree in Business Administration, Accounting, or Health Care Administration preferred

· Minimum 3 years of experience in the healthcare industry (particularly, working with Medicaid and Managed Medicaid insurance companies)

· Medical billing, medical coding, medical administration certificate, or diploma program highly preferred

· One to three years of training and experience in Revenue Cycle functions highly preferred

· Educated on and compliant with HIPAA regulations. Understand medical terminology and maintain strict confidentiality of patient and client information.

· Experience with CareLogic system preferred

· Strong understanding of Microsoft applications; i.e. Excel, Outlook, Word, PowerPoint

· Ability to investigate problems and develop/communicate solutions

· Excellent and professional customer service to internal and external customers.