What are the responsibilities and job description for the RCM SPECIALIST position at USOP, LLC?
RESPONSIBILITIES :
- Daily insurance claim submission and follow-up
- Claim Scrub for clean claim submission.
- 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.
- Understands and abides by CMS and other payer guidelines in coding and billing.
- Must be familiar with and remain updated on ICD-10, CPT codes, and medical terminology.
- Research coding and claims questions thoroughly in order to maintain high quality standards.
- Ensures appropriate modifiers are assigned when needed to claim.
- 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
- Any other duties and/ or special projects as assigned.
EXPERIENCE / EDUCATIONAL REQUIREMENTS:
Education:
Graduate of four-year high school or equivalent (GED).
Experience
- 3 - 5 years: Three to five years healthcare RCM experience related to the described duties.
- Skills and Knowledge of EMR software functionality and operations.
- Proficiency in Microsoft Office Applications.
ADDITIONAL SKILLS AND EXPERIENCE:
- Always provide a high level of quality patient care and customer service.
- Plan, prioritize, and complete tasks as delegated by RCM leadership.
- Maintain composure and set a professional example daily.
- Communicate clearly with patients and team members through telephone, email and in-person.
Skills
ICD-10
EMR systems
Accounts Receivable
High School diploma or GED
Education
Required- High School or better
Behaviors
Required- Team Player: Works well as a member of a group
Motivations
Required- Goal Completion: Inspired to perform well by the completion of tasks
