Weight Management Insurance Verification Specialist

Job Title: RPM/CCM Insurance Verification & Revenue Cycle Manager

Job Summary: The RPM/CCM Insurance Verification & Revenue Cycle Manager is responsible for overseeing both insurance verification and revenue cycle management for Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) programs. Using software programs such as Inovalon, Availity, Clinii, Mindbody Logic, and other third-party clearinghouse platforms, this role ensures accurate insurance verification, eligibility determination, prior authorizations, and billing processes. The manager is also responsible for overseeing the entire revenue cycle process, ensuring timely claims submission, effective follow-up on denials, and resolution of outstanding balances to maximize revenue collection.

Key Responsibilities:

• Insurance Verification & Authorization:
• Verify patient insurance coverage and eligibility for RPM and CCM services using Inovalon, Availity, Clinii, Mindbody Logic, and other third-party clearinghouse platforms.
• Review insurance policies, benefits, and guidelines to determine coverage for RPM and CCM services, ensuring all necessary authorizations are obtained before services are provided.
• Communicate with insurance companies, patients, and healthcare providers to resolve coverage issues and discrepancies.
• Track and follow up on pending authorization requests to ensure timely approvals and avoid service delays.
• Revenue Cycle Management:
• Oversee the entire revenue cycle process, from insurance verification through claim submission, payment posting, and collections.
• Ensure timely and accurate submission of claims using Inovalon, Availity, Clinii, Mindbody Logic, and other clearinghouse software.
• Review and resolve claim denials and rejections, ensuring all necessary actions are taken to correct and resubmit claims for reimbursement.
• Manage the follow-up on outstanding accounts, ensuring collection efforts are maximized and aged receivables are minimized.
• Team Leadership & Collaboration:
• Lead and manage a team of billing specialists, insurance verification specialists, and other revenue cycle staff, providing training, guidance, and support to ensure efficient operations.
• Collaborate closely with clinical and administrative teams to ensure seamless coordination between insurance verification, service delivery, and billing functions.
• Train staff on software platforms such as Inovalon, Availity, Clinii, Mindbody Logic, and other clearinghouse systems, ensuring proficiency and accuracy in using these tools.
• Reporting & Analysis:
• Monitor and analyze revenue cycle metrics, including days in accounts receivable, claim denial rates, and payment delays, and implement corrective actions as needed.
• Prepare and present financial reports to senior management, including key performance indicators related to revenue cycle performance.
• Ensure compliance with regulatory requirements, payer guidelines, and organizational policies in all aspects of insurance verification, billing, and collections.
• Process Improvement & Compliance:
• Develop and implement policies and procedures to improve the efficiency and accuracy of the insurance verification and revenue cycle processes.
• Stay up to date on industry trends, payer changes, and updates to Inovalon, Availity, Clinii, Mindbody Logic, and other clearinghouse software platforms.
• Ensure compliance with federal and state regulations, payer contracts, and insurance requirements to prevent billing errors and minimize compliance risks.

Qualifications:

• Clinical, Nutrition, Medical, and Weight Management experience a plus
• in insurance verification, RPM, and CCM programs.
• In-depth knowledge of insurance verification, claims processing, and payment posting.
• Experience managing a team of billing and insurance verification specialists.
• Strong understanding of medical coding (CPT, ICD-10, HCPCS) and medical billing practices.
• Excellent problem-solving, organizational, and communication skills, with the ability to interact

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Experience:

• Nutrition: 1 year (Preferred)

Ability to Commute:

• Gainesville, GA 30503 (Required)

Ability to Relocate:

• Gainesville, GA 30503: Relocate before starting work (Required)

Work Location: In person

Salary : $18 - $22