What are the responsibilities and job description for the Revenue Cycle Management Specialist position at Gravity Diagnostics?
Revenue Cycle Management Specialist
Department: Revenue Cycle Management
Reports to: Revenue Cycle Management Supervisor
Pay Group: Non-Exempt (Hourly)
Job Summary:
The RCM Specialist is responsible for assigned segment(s) of the revenue cycle such as preparing and submitting claims to appropriate third-party payors, reviewing claims to ensure specific payor billing requirements are met, resolving billing inquiries and problems, payment review and posting, patient account follow up, and resolution of identified problems. You should be adaptable in a fast-paced environment and will have the ability to exercise sound judgment and a high work ethic. A successful candidate will show commitment to success and the desire to continue growth in both technical and functional aspects of this role.
Responsibilities and Duties:
Department: Revenue Cycle Management
Reports to: Revenue Cycle Management Supervisor
Pay Group: Non-Exempt (Hourly)
Job Summary:
The RCM Specialist is responsible for assigned segment(s) of the revenue cycle such as preparing and submitting claims to appropriate third-party payors, reviewing claims to ensure specific payor billing requirements are met, resolving billing inquiries and problems, payment review and posting, patient account follow up, and resolution of identified problems. You should be adaptable in a fast-paced environment and will have the ability to exercise sound judgment and a high work ethic. A successful candidate will show commitment to success and the desire to continue growth in both technical and functional aspects of this role.
Responsibilities and Duties:
- Collect all relevant documentation for claim submission. Collaborate with others to ensure claim data is complete and accurate.
- Update and maintain patient billing records and ensure documents are current.
- Review records for completeness. Contact providers/clinical staff for clarification on procedures/diagnoses and to obtain missing information.
- Complete patient insurance eligibility/benefits verification for government and commercial insurance claims.
- Review charges and process/submit claims to third party payors.
- Monitor accounts and perform follow up activities to ensure accounts remain current.
- Review reports and accounts; research and resolve issues.
- Review payment posting and resolve payment and billing errors.
- Monitor and update delinquent account status and recommend accounts for collection or write off.
- Contact payors to secure past due balances, verify demographics and billing information, update information in system(s) and document conversations.
- Update and maintain patient billing records and ensure documents are current.
- Monitor and review credit balances for timely refunds within government guidelines/regulations.
- Identify and report payor trends, rejections patterns, and delays to management.
- Remain current on billing & coding rules and requirements.
- Adhere to applicable laws regarding confidentiality and maintenance of patient records.
- Other duties as assigned
Required Skills and Abilities:
- Excellent verbal and written communication skills.
- Excellent customer service skills.
- Excellent organizational skills and attention to detail.
- Excellent time management skills with a proven ability to meet deadlines.
- Strong analytical and problem-solving skills.
- Ability to function well in a high-paced and at times stressful environment.
- Proficient with Microsoft Office Suite or related software.
Education and Experience:
- HS diploma or equivalent required, some college preferred.
- Working knowledge of state/federal/third party claims processing.
- Proficiency with computer systems, including Microsoft Office and electronic health/billing software platforms.
- Minimum 2 years medical billing/coding/insurance claims filing & follow up required.
- Medical coding certification and/or lab experience preferred.
Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift up to 15 pounds.
Gravity Diagnostics is an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their race, color, religion, national origin, ancestry, alienage or citizenship status, age, sex, gender, gender identity, gender expression, sexual orientation, marital status, disability, military service and veteran status, pregnancy, childbirth, and related medical conditions, or any other characteristic protected by applicable federal, state or local laws.
Gravity Diagnostics will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business.
