RCM Credits Specialist, Lead

Follows up on claims with credit balances both patient and insurance balances using Explanation of Benefits (EOB). RCM Credits Specialist Lead has assigned specific books of business based on Financial Class and Payers. Work to support the field related to claim denials. Work with Credits Team to support, motivate, and unite through open communication and assistance with their accounts. Provide additional training for established staff as well as new.

Daily Duties

• Follows up on claims with outstanding credit balance for both patient and insurance.
• Monitor, review, and respond to Hub (field) communication inquiries within the 48-hour requirement.

Account Follow-Up

• Responds to written and telephone inquiries from insurance companies
• Builds and Maintain relationships with personnel from assigned carriers
• Meets with Supervisor regularly to discuss and solve patient and insurance credit follow up concerns,

Lead Function  

• Works with Supervisor to coordinate special projects for assigned team members. Ensures projects are completed within deadline constraints.
• Provides front line support for team by answering and fielding questions. Forwards to appropriate contact when unable to answer question or resolve issue.
• Supports all team members by communicating the most current information regarding carrier specific rules, department processes and company policies.
• Responsible for New Hire Training in all aspects of the role.
• Works with RCM Manager to ensure team members receive initial training and additional training as needed.

Other

• Demonstrate professionalism and promote positive interpersonal relations with all internal and external business contacts, representing the corporation in a positive manner, displaying personal commitment to achieving the goals and objectives of the corporation.
• Maintain patient confidentiality; comply with HIPAA and compliance guidelines established by the practice to protect RCM operations by keeping information confidential.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends all meetings as requested including regular staff meetings.
• Performs any additional duties as requested by management.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies. 

EDUCATIONAL REQUIREMENTS:

• High school diploma, or equivalent, required
• College education or trade school preferred

QUALIFICATIONS AND EXPERIENCE:

• Previous Medical Billing and Collections experience preferred. Preference for those with a minimum of eighteen months experience.
• Comfortable using email and interacting with Internet applications
• Knowledge of practice management and Microsoft processing software
• Proven understanding of Explanation of Benefits forms, claim forms and the insurance billing process
• Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
• Basic knowledge of CPT and ICD-10 coding
• Strong written and verbal communication skills

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds.  Position requires prolonged sitting, some bending, stooping, and stretching.  Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required.  Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.

Typical Working Conditions

Professional office environment.  If remote, must have functioning internet and are open to on-camera team calls. Occasional evening or weekend work.