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