RCM Accounts Receivable Specialist

RCM Specialist has the role of accounts receivable follow-up and charge entry processing.  The position is responsible for the overall recovery and management of the clients’ Revenue Cycle.  The position enhances all phases of RCM.  Additionally, the position supports the company’s overall operations and client services by effectively and efficiently driving the Revenue Cycle Management process and delivering successful outcomes.

Reports To:  RCM A/R Manager

Responsibilities

• Effectively review and research claims denials and contact payers to verify detailed denial reasons when necessary.
• Contact patients to obtain accurate insurance information.

• Phone appeals & reconsiderations for denied or rejected claims.
• Identify and communicate denial/rejection trends to management.
• Identify and resolve discrepancies. 
• Navigate and research insurance policies & benefits for policy exclusions for patients.
• Navigate and research payer medical reimbursement policies and exclusions.
• Complete request for reconsideration forms while following payer requirements.
• Prepare documentation and file appeals and reconsiderations as appropriate.
• Review and work all daily correspondence received from patients and payers.
• Must be aware of and comply with the timely filing guidelines associated with reconsiderations and appeals for assigned payers.
• Work with payer websites.
• Work aged AR according to defined processes.
• EDI transactions/troubleshooting 
• Must be familiar with financial reporting.
• Must adhere to all HIPAA guidelines/regulations. 
• Special projects and other assigned duties

 Qualifications

• 2-4 years of medical billing and collections  preferred.
• Must exhibit excellent time management, organizational skills, and be computer literate.
• 10 Key – accuracy and proficiency              
• Ability to work independently and adapt to a fast-changing environment. 
• Demonstrated knowledge of Medicare, Medicaid, MCO’s, and commercial insurance. 
• Strong problem-solving and critical thinking skills
• Strong interpersonal and communications skills both verbal and written. 
• Must have ICD-10/CPT knowledge.