RCM SPECIALIST

Essential Job Duties:

· Responsible for working and posting claims of patients covered under private and public plans while posting appropriate updates and statuses in the RCM system.

· Work appeals/denials in a timely manner and creates solutions to prevent future denials.

· Research/process credits (recoupments and refunds) to insurance companies and patients as appropriate

· Reviews and analyzes patient accounts to determine accurate levels of coding and other billable services.

· Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well.

· Handles precertification procedures pertaining to patients by collecting insurance information and entering information into Prime Suite system.

· Verifies insurance benefits/coverage by contacting insurance companies; obtains insurance information for precertification for procedure; works with insurance company, health care provider & patient to get claims processed & paid.

· Answers patient inquiries in a professional & courteous manner.

· Records benefit and certification information into the applicable computer system and communicates with scheduling in accordance to established work processes.

· Able to utilize and leverage Microsoft Office products (PowerPoint, Excel, Word, Outlook)

· Experience with Modernizing Medicine practice management system and orthopedic billing and collections a plus

· Performs other duties as assigned.

Education:

· High School Diploma or equivalent required.

· 3 - 5 years Healthcare RCM experience related to the described duties.

Additional Requirements:

· Knowledge of medical terminology and procedures, knowledge of health insurance industry practices and/or medical billing procedures.

· Experience with medical scheduling/billing systems preferred.

· Exceptional customer service, interpersonal skills, and communication skills

· Proficiency of electronic records systems preferred. Must have strong data entry skills.

· Must be able to complete tasks with a high-degree of efficiency and accuracy while working in a fast-paced environment with frequent disruptions.

· Must demonstrate ability to analyze data and resolve complex problems.

· Must have the ability to work independently while managing time and workload appropriately.

· Must be able to travel to all clinic locations and work overtime hours as needed.

Job Type: Full-time

Remote: None