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RCM Specialist - Collections ID-21156

Overview:

The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances.

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Responsibilities:

  • Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.
  • Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.
  • Collaborate with internal teams to address claims challenges and improve revenue cycle.
  • Escalate complex or uncollectible accounts to management for further action.
  • Submit appeals/claim corrections as needed within timely filing limits.
  • Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.
  • Payer projects as assigned.
  • Identify and report trends in claim denials and payment challenges.
  • Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about
  • Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.
  • Assist in the implementation of processes to measure, assess, and improve the performance of the RCM department activities of the company.
  • Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement "best practices" in all departmental
  • Participate in surveys conducted by authorized inspection
  • Participate in the company's Performance Improvement program as requested by the Performance Improvement
  • Participate in company committees when
  • Participate in in-service education programs provided by the company.
  • Pursue continuing education programs appropriate to job
  • Perform other duties as assigned by
  • Complete all mandatory and regulatory training programs.
  • Report any misconduct, suspicious or unethical activities to the Compliance
  • Complies with accepted professional standards and practice.

Qualifications:

Job Skill Requirements:
  • Ability to read and interpret medical records for billing purposes.
  • Competent in mathematic equations.
  • Ability to compute unit conversions for drugs.
  • Understanding of CPT, HCPCS, ICD-10, and NDC codes
  • Diligent attention to detail.
  • Excellent verbal and written communication.
  • Understanding of HIPAA compliance.
  • Self-directed, has the ability to work with little supervision.
  • Proficiency in Excel, Outlook, and all other office applications.
  • Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)
  • Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.
  • Deep understanding of home infusion process, therapies, and related services.
  • Ability to understand payer explanation of benefits.
Educational Requirements:
  • High school diploma or GED
Experience:
  • One to three years of experience in Home Infusion or Specialty Pharmacy collections.
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