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