BASIC FUNCTION

The RCM Billing Specialist I is responsible for managing and processing patient billing, claims, and payments for healthcare services. This position requires strong attention to detail, excellent communication skills, and the ability to handle complex billing processes. The role involves ensuring that patient accounts are accurate, claims are submitted promptly, and outstanding balances are collected in a timely manner.

PRIMARY RESPONSIBILITIES AND DUTIES

Verify patient insurance coverage and eligibility prior to claim submission.

Contact patients and insurance companies to follow up on outstanding claims and payments.

Set up payment plans with patients when necessary and monitor adherence to payment schedules.

Assesses accuracy of demographic and policy information within patient accounts.

Responsible for charge and payment entry within medical software program.

Prepare and submit medical claims to insurance companies and other payers, ensuring accuracy and compliance with industry regulations.

Reconcile patient accounts by reviewing balances, payments, and adjustments.

Investigate and resolve account discrepancies or billing issues.

Document all collections activities and update patient account records accordingly.

Assists in reconciling insurance deposits and patient collections.

Coordinates with Front Desk staff regarding collection of current or past due patient balances, co-pays, deductibles, etc. Available to answer billing and charge related inquiries.

Provide excellent customer service by answering patient inquiries regarding billing statements and insurance claims.

Educate patients about their billing statements, payment options, and insurance coverage.

Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to insure a professional, responsible and courteous environment.

Promotes effective working relations and works effectively as part of a team to facilitate the departments ability to meet its goals and objectives.

Performs other duties as assigned.

MISSION, VISION, AND VALUES

• Empathy - Demonstrates empathy and respect for diversity in the workplace by treating all patients, guests, and colleagues with politeness and inclusivity. Open to learning from different perspectives and experiences.
• Excellence - Maintains ethical and safety standards and shows integrity in work-related activities. Aims for excellence in job performance.
• Enjoyment - Shows gratitude, appreciation, a commitment to learning, and professionalism by seeking feedback, accepting constructive criticism, and being open to growth and improvement in their job role.
• Commitment to Patient/Customer Service - Exhibits good patient/customer service skills and professionalism during patient, customer, colleague interactions. Uses effective communication skills, listens to patients/customers, and responds to inquiries and concerns in a timely manner. Handles challenging situations professionally, ensuring timely resolution of problems to create positive patient/customer experiences.

CULTURE

• Gratitude - Maintains a positive attitude and acknowledges the value of contentment and well-being in oneself and others.
• Collaborative Team - Shows adaptability, enthusiasm, and a readiness to work with others in an inter-professional team for organizational purposes. Identifies and encourages opportunities for the professional growth of team members.
• Quality Improvement - Works together with the team to promote ongoing improvement efforts aimed at enhancing quality standards, processes, and results.
• Accountability - Follows regulatory guidelines and HealthPoint policies and procedures consistently. Takes responsibility for mistakes and errors when they occur.

QUALIFICATIONS:

PROFESSIONAL/TECHNICAL KNOWLEDGE, SKILLS & ABILITIES

Required

High School Diploma equivalent required.

A minimum of 1 year of medical billing experience

Preferred

3 - 5 years of medical billing experience preferred.

Some training or background in medical coding preferred.

Knowledge of medical terminology and billing practices preferred.

LICENSES & CERTIFICATIONS

TECHNICAL SKILLS

Knowledge of medical terminology and billing practices preferred.

Physical Demands: Work is performed in a typical office environment with period work in a medical clinic setting.