Revenue Cycle Management Specialist

Revenue Cycle Management Specialist

Revenue Cycle Management Specialist

Revenue Cycle Management (RCM) is the financial process, utilizing medical billing software, that healthcare providers use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.

The RCM Specialist is responsible for working independently, exceling at problem solving and self-learning.

Job Requirements:

• A Bachelor's Degree in Accounting, Banking, Business Administration or related field
• At least 3 years’ experience in Accounting or any other related field
• Proven successful supervisory skills.
• Flexibility, ability to work under pressure, meet deadlines and work on shifts
• Excellent computer skills
• Great attention to details
• Excellent interpersonal skills
• Ability to communicate with persons at all levels 

Essential Job Responsibilities:

• Responsible for submission of insurance claims via electronic clearinghouse and paper claims via mail
• Perform audits of assigned accounts before submitting claims to ensure accuracy and validity
• Provide continual follow-up within the billing software to ensure claims are received by insurance companies appropriately
• Reviews claim holds and facilitates clean claim processing
• Work within the department and with the other departments to ensure precise submission of claims
• Ensure patient demographics are correctly entered in the billing software
• Participates in companywide and departmental meetings
• Commits to providing excellent customer service while maintaining the highest degree of professionalism while working in a team environment to meet goals
• Adheres to all company policies and procedures
• Understands and complies with all HIPAA rules and regulations
• Reviews all open claims for collection efforts needed
• Review and effectively troubleshoot all known denials and rejections through correspondence or telecommunication.
• Making outbound collection calls to commercial payers in a professional manner
• Resolves insurance related problems and reduces accounts receivable delinquency, applying professional customer service skills in a timely manner.
• Make demand on insurance due payments in accordance with payment due dates, state and federal regulation.
• Identify issues attributing to account delinquency and non-payment and discuss them with direct manager.
• Review and monitor assigned accounts and all applicable collection reports and other insurance due related duties as assigned.
• Provide timely follow-up on payment guarantees and claims rebilled for payment
• Mail correspondence to customers/insurers to encourage payment of delinquent accounts and make certain scans of all outgoing demands are made.
• Faxes documents, medical records, authorizations or other requested information (within reason) to insurers and perform follow up as required to maintain company standards.
• Seeks and recommends ways to use technology to improve operational efficiency.
• Maintains patient confidentiality by following the HIPAA Compliance Plan established by the practice.
• Attends all meetings as requested and performs any additional duties as requested by Executive Management. 

Key Competencies

• Critical thinking, decision-making ability and sound judgement.
• Excellent organizational and time management skills.
• Flexibility and capacity to adapt quickly to changing situations.
• Ability to work effectively and harmoniously in work teams and instill confidence in others.
• High level of accuracy and thoroughness in all aspects of work.
• Strong professional maturity, initiative, and sound discipline.
• Good oral and written communication skills suited for diverse internal and external audiences. 

We thank all applicants for their interest; however, only short-listed candidates will be contacted. We are an equal opportunity employer.