Revenue Cycle Management Specialist

Summary:

Advanced Wound Therapy - AWT (the Company) is a leading provider of mobile wound care services, delivering expert clinical care directly to patients in their homes, nursing homes, and assisted living facilities. We are committed to improving patient outcomes and providing accessible, high-quality healthcare. The Revenue Cycle Management (RCM) Specialist for Advanced Wound Therapy - AWT, is responsible for ensuring the efficient and accurate processing of all revenue-related activities. This role plays a critical part in maximizing revenue collection and minimizing financial risk for our mobile wound care business. The ideal candidate will possess a strong understanding of medical billing, coding, and insurance regulations, with a proven ability to optimize revenue cycle performance.

Essential Duties and Responsibilities:

• Billing and Coding:
• Accurate and timely submission of medical claims to various payers (Medicare, Medicaid, commercial insurance).
• Proficient application of ICD-10, CPT, and HCPCS codes.
• Review and verification of patient demographic and insurance information.
• Stay updated on coding and billing changes and regulations.
• Claims Management:
• Monitor claim status and resolve claim denials and rejections.
• Process appeals and manage claim follow-up to ensure timely reimbursement.
• Identify and address root causes of claim denials and implement corrective actions.
• Payment Posting and Reconciliation:
• Assist the Finance department in confirming accurate and timely posting of payments from various sources.
• Reconcile payments with Explanation of Benefits (EOBs) and resolve discrepancies.
• Generate and analyze aging reports to identify outstanding balances.
• Patient Collections:
• Manage patient billing inquiries and resolve billing disputes.
• Process patient statements and manage patient payment plans.
• Communicate effectively with patients regarding billing and payment issues.
• Reporting and Analysis:
• Generate and analyze revenue cycle reports to identify trends and areas for improvement.
• Monitor key performance indicators (KPIs) such as days in accounts receivable (DAR), clean claim rate, and denial rate.
• Provide regular updates to management on revenue cycle performance.
• Compliance:
• Ensure compliance with all relevant federal, state, and local regulations, including HIPAA.
• Maintain current knowledge of payer policies and procedures.
• Participate in internal and external audits as required.
• Software and Systems:
• Proficient use of Electronic Health Record (EHR) and Practice Management (PM) systems.
• Maintain and update patient billing information within the systems.
• Assist in the implementation and optimization of billing and collection software.
• General Requirements:
• Must adhere to the policies, principles, and guidance within the Employee Handbook and Code of Business Conduct
• Must conduct self in an ethical, legal, and responsible manner always
• Attends all mandatory meetings, training, and assignments as delegated
• Perform other duties and responsibilities as assigned

Qualifications:

• Minimum of 5 years of experience in medical revenue cycle management, preferably in a mobile healthcare or home health setting.
• Strong understanding of medical billing, coding, and insurance regulations.
• Proficiency in ICD-10, CPT, and HCPCS coding.
• Experience with Medicare, Medicaid, and commercial insurance billing.
• Excellent communication, interpersonal, and problem-solving skills.
• Strong attention to detail and accuracy.
• Ability to work independently and as part of a team.
• Proficiency in using EHR and PM systems.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) certification preferred.
• High school diploma or equivalent required, bachelor’s degree in healthcare administration, business, or related field preferred.

Skills:

• Medical Billing and Coding
• Claims Management
• Payment Posting and Reconciliation
• Patient Collections
• Revenue Cycle Analysis
• HIPAA Compliance
• EHR/PM Systems Proficiency
• Communication and Interpersonal Skills
• Problem-Solving
• Attention to Detail

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• Sit for long periods.
• Use their hands to handle general office equipment, tools, or controls.
• Repeat the same movements.
• Understand the speech of another person.
• Speak clearly so listeners can understand.
• See details of objects that are less than a few feet away.

Job Type: Full-time

Pay: $30.00 - $35.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No nights
• No weekends

Work Location: In person

Salary : $30 - $35