RCM Specialist - Collections
Overview:
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The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances.
Responsibilities:
- Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.
- Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.
- Collaborate with internal teams to address claims challenges and improve revenue cycle.
- Escalate complex or uncollectible accounts to management for further action.
- Submit appeals/claim corrections as needed within timely filing limits.
- Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.
- Payer projects as assigned.
- Identify and report trends in claim denials and payment challenges.
- Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about
- Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.
- Assist in the implementation of processes to measure, assess, and improve the performance of the RCM department activities of the company.
- Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement "best practices" in all departmental
- Participate in surveys conducted by authorized inspection
- Participate in the company's Performance Improvement program as requested by the Performance Improvement
- Participate in company committees when
- Participate in in-service education programs provided by the company.
- Pursue continuing education programs appropriate to job
- Perform other duties as assigned by
- Complete all mandatory and regulatory training programs.
- Report any misconduct, suspicious or unethical activities to the Compliance
- Complies with accepted professional standards and practice.
Job Skill Requirements:
- Ability to read and interpret medical records for billing purposes.
- Competent in mathematic equations.
- Ability to compute unit conversions for drugs.
- Understanding of CPT, HCPCS, ICD-10, and NDC codes
- Diligent attention to detail.
- Excellent verbal and written communication.
- Understanding of HIPAA compliance.
- Self-directed, has the ability to work with little supervision.
- Proficiency in Excel, Outlook, and all other office applications.
- Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)
- Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.
- Deep understanding of home infusion process, therapies, and related services.
- Ability to understand payer explanation of benefits.
Educational Requirements:
- High school diploma or GED
Experience:
- One to three years of experience in Home Infusion or Specialty Pharmacy collections.