Revenue Cycle Management (RCM) Specialist

Ready to make a real difference in people’s lives? ActivStyle is seeking compassionate, driven individuals to join our team—where purpose meets professionalism. As a trusted provider of home-delivered medical supplies, we empower our clients to live with dignity, independence, and comfort.

ActivStyle is currently hiring for a dedicated Revenue Cycle Management (RCM) Specialist in our St. Paul Office. In this role, you’ll be responsible for maintaining a timely revenue cycle for all essential products like incontinence supplies, urological items, and other personal care essentials provided by ActivStyle.

If you’re passionate about helping others and thrive in a supportive, mission-driven environment, we’d love to welcome you to the ActivStyle family.

Position Summary:

Revenue Cycle Management Specialist are responsible for maintaining a timely revenue cycle for all the goods and services provided by ActivStyle. Also responsible for maintaining patient confidentiality and function within the guidelines of HIPAA. Completes assigned compliance training and other educational programs as required. Maintains compliant with ActivStyle’s Compliance Program.

Essential Functions and Job Responsibilities:

Account Receivable

• Ensure organization receives accurate payment for goods & services provided according to contracted rates and/or payer fee schedules.
• Collect on accounts by sending claims/invoices/statements by means of phone, email, fax, mail, or websites.
• Reconcile the accounts receivable to ensure that all payments are accounted for and properly posted.
• 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.
• Research and resolve payment discrepancies.
• Works to resolve credit balances and issue insurance and or patient refunds as needed
• Identify and verify that billing complies with policies and procedures.
• Identify trends and root causes related to inaccurate payments and escalate as appropriate.
• Takes and makes inbound/outbound calls from internal and external clients to resolve any issues that may arise

Authorization

• Collaborate with internal & external customers to provide status updates & coordinate appeals on denied authorization.
• Resolves pending revenue by reconciling approved authorizations and pending charges.

Confirmation

• Ensure order will bill correctly to insurance.
• Ensure order has valid proof of delivery.

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.
• Identifies claim rejections and escalates as appropriate to facilitate educational opportunities or process improvements.
• Maintains daily, weekly, monthly system/database functions and performs routine functions as defined by leadership.
• Review assigned payers requirements on a consistent basis for any fee schedule updates, in addition to reviewing payer notifications received via mail, email, or websites and alerting supervisor of any changes

Unbilled Revenue

• Analyze billing edits to ensure compliance to payer requirements.
• Resolve pending revenue by reconciling received documentation and pending charges.
• Performs extensive account audits and ensures proper billing for services to the accurate payer.
• Ensure proper revenue recognition for billed charges and services moving forward.

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.
• Resolve private pay charges for returned payments due returned payments.
• Resolve accounts pertaining to patient account inaccuracies or patient demographics.

RCM Project

• Responsible for updating data elements that drive revenue generation and decrease denial rates.
• Work collaboratively with RCM leadership to maximize RCM overall productivity.
• Adhere to frameworks and maintain documentation appropriately.
• Assume responsibility for independent completion of tasks and small projects.

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.
• Develop and maintain working knowledge of current HME products and services offered by the company.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with ActivStyle’s Compliance Program
• Performs other related duties as assigned.

Competency, Skills and Abilities:

• Decision Making
• 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.

Education and Experience Requirements:

• High School Diploma or equivalent
• One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

Amazing Benefits At A Glance:

• Team Driven and Values Based Culture
• Medical, Dental, and Vision Benefits
• Paid Time Off (PTO), Holiday Pay, Sick and Safe Time for Applicable States
• Employee Assistance Program
• Career Growth Opportunities
• 401(k) and Generous Employer Match Opportunity
• The pay for this position is $18/hour

At ActivStyle we don’t just accept difference - we celebrate it, we support it, and we thrive on it for the benefit of our team and our community. We are proud to be an equal opportunity workplace and an affirmative action employer.

This employer participates in E-Verify. Following acceptance of any job offer, at the start of employment the employer will provide the federal government Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify is unable to verify your eligibility for employment this employer will provide written instructions to provide an opportunity to contact the appropriate agencies and resolve the discrepancy prior to taking any action against continued employment.