RCM A/R Specialist

The Role:

The RCM A/R Specialist is responsible for all workflows related to the back-end billing and collections cycle for our client. The position requires expertise in the life cycle of medical claims, knowledge of payer regulations, both local and national payers, and the ability to work efficiently within our internal EHR system and practice management system.

To be successful in this role, you should be able to have very acute attention to detail and be able to provide excellent customer service. Strong communications skills to include direct contact to the appropriate third-party payers and members as needed. You are excited about our mission and committed to helping people through a sometimes difficult system.

What you will do:

• Review denied claims based on assigned markets, payers and work queues within our practice management system
• Accurately and efficiently processes requests for denied claims information using website portals and outbound phone calls for all Commercial, Medicare and Medicaid insurance payers
• Researches and responds to documentation requests from insurance carriers in a timely manner.
• Processes appeals of insurance denials and follows-up until the appeal is resolved.
• Obtains, reviews and updates patient demographics and insurance information within both EHR and practice management billing system as needed.
• Complete timely follow-up on claims submitted to payer, but no response or ERA after 45 days to resolve any pending issues with claim and payer within timely filing limits.
• Documents clear and concise activities performed in the system for each account worked.
• Adheres to all HIPAA (Health Insurance Accountability and Portability Act) guidelines and regulations
• Ability to consistently maintain productivity and quality expectations as defined by the leadership team
• Alert management to irregularities, insurance trends and areas of concern with reimbursement
• Completes other tasks and projects as assigned by RCM Leadership.
  
  
  

You are a good fit if you have:

• Bachelor's Degree or Equivalent experience
• 3 or more years of experience in physician group practice in a denial management role.
• Prior experience resolving out of network denials, and value based (bundle) claims.
• Proficient in CPT and ICD-10 coding terminology
• Enjoy working in a fast paced and rapidly changing environment.
• Strong relationship building skills both external and internal.
• Thrive on working independently