RCM Primary Care Follow Up Specialist | UMC Physicians

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Title: RCM Primary Care Follow Up
Department: Central Business Office

We are seeking a full-time team member with a passion for others to work at UMC Physicians. The RCM Primary Care Follow Up position is responsible for ensuring accurate and timely submission of insurance claims, obtaining missing information, researching denials and documentation, following up on claims, and maintaining compliance with department standards, HIPAA, and governing agency policies and procedures.

Preferred Characteristics:

• Goal oriented
• Professional demeanor and appearance
• Punctual and dependable
• Problem solving and critical thinking abilities
• Teamwork
• Organization and time management, ability to multi-task and meet

deadlines

Availability Requirements:

• Ability to work 40 hours per week
• Day Shifts between the hours of 7:30 – 5:30
• 8-hour shifts Monday – Friday
• 9-hour shifts Monday – Thursday | 4-hour shift Friday

Our Mission: To improve the quality of life for our community by providing the best patient experience for every patient.

Our Vision: To be the best place to work and the best place to receive healthcare.

Benefits: UMC Physicians offers a comprehensive benefits package to eligible full-time employees. Benefits include:

• Paid Time Off
• Sick Pay
• Medical, Dental and Vision Insurance
• Employer Paid Group Life and Voluntary Life Insurance
• Short Term Disability Insurance
• Long Term Disability (after 2 years of employment)
• Critical Illness, Accident and Cancer Insurance
• Health Care and Dependent Care Spending Accounts
• 401K Retirement Plan with Company Match
• Employee Assistance Program

Note: Some benefits require an employee contribution to participate.

Job Description:
The RCM Primary Care Follow Up position ensures all initial third party and federal/state government claims are billed and all unpaid, rejected or denied claims receive appropriate follow up or an appeal to over-turn the denial as required. Accurate and timely preparation and submittal of corrected claims to payers via electronic (837) or paper is also required. The RCM Primary Care Follow Up position must take action required to resolve rejected, underpaid and denied claims by submitting corrected claims and appeals on a timely basis upon review of unpaid encounters. They must also identify and resolve complex claims issues adversely impacting the revenue cycle and achieve resolution through coordination with clinical departments and the payer. This position works closely with the Central Billing Office Administration, clinical practice mangers, billers, and coders.

Essential Functions:

• Review, research and resolve coding denials for primary care providers; this
• includes denials related to the billed CPT, diagnosis, and modifier
• Identification of denial, payment, and coding trends in an effort to decrease
• denials, improve denial prevention, and maximize collections
• Contact payers via website, phone and/or correspondence, regarding
• reimbursement of claims denied
• Interpret medical policies and/or Medicare and Medicaid rules and
• regulations to ensure proper reimbursement/collection
• Prepare and submit claims appeals, based on payor guidelines

Additional Responsibilities:
Additional duties as assigned

Skills and Abilities:

• Requires knowledge of carrier specific claims appeal guidelines to includes

claim logic, internet, and paper/fax processes

• Requires proven analytical and decision making to determine what

selective clinical information must be submitted to properly appeal the
denial

• Requires proven knowledge of CPT and ICD-10 coverage policies, internal

revenue cycle coding processes and the billing practices of the specialty
service line

• Requires clear and concise written and oral communication with payors,

providers, and billing staff to ensure resolution of denials

• Requires the ability to read and interpret E&M notes, complex diagnostic

study results, endoscopic and interventional results and/or major surgical
operative notes.

• Determine appropriate action for denial resolution based on documentation
• Requires proven knowledge of the specialty specific service line

documentation requirements.

Minimum Qualifications:

• High School diploma or equivalent
• 1-2 years of medical billing or collections required (combination of higher

education and experience may be considered to satisfy years of
experience requirement)

• Type 40wpm, 10 key by touch
• Strong analytical and critical thinking
• Excellent communication skills
• Strong attention to detail
• Mature, sincere, and dedicated attitude

Preferred qualifications:

• Knowledge of Medicare, Medicaid, and Commercial Insurance procedures
• Denial management, billing/coding guidelines
• Experience in primary care

Environmental Conditions:
Works in well-lighted, heated and ventilated building. Exposure to blood borne pathogens are of low risk. Hours of duty may be irregular.

Physical Requirements:
Requires prolonged sitting, some bending, lifting, stooping, and stretching. Hand-eye coordination and manual dexterity sufficient to operate a keyboard, copier, telephone, adding machine, fax machine, printers and other minor office equipment is a must. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Must also be able to communicate in person, via voicemail, vie email and on the telephone.

Limitations and disclaimer:
The above job description is meant to describe the general nature of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. This position is security sensitive.
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