RCM Specialist

Description:

Title: RCM Specialist

Reports to: Director of Revenue Cycle Management / Revenue Cycle Manager

Department/Location: Remote

FLSA Status: Exempt

Travel Requirement: None

Summary: 

The RCM Specialist, reporting to the Senior Director of RCM, will be responsible for all aspects of the claim cycle from verification of benefits, patient financial counseling, utilization review follow-up, front end billing, claim data integrity, and AR follow up.   

Responsibilities: 

• Verification of Benefits
  • Verify insurance eligibility and benefits prior to admission. Including deductible, co-insurance, copay, treatment restrictions, premium paid through dates, coordination of benefits completion, and in or out of network status.
• Financial Counseling
  • Walk through insurance benefits with patients prior to admission. Go over and have them complete all applicable financial forms. Collect patient cost share.
• Utilization Review Follow Up
  • Run a daily report on pending authorizations, call the insurance care managers to obtain the authorization details and input into KIPU EMR for visibility to RCM and clinical team members. Coordinate with therapists on any auth issues or other information needed by the insurance company.
• Front End Billing / Charge Entry / Claim Data Integrity
  • Run the daily billing census report to identify and partner with appropriate team members to remove billing errors within the EMR. As we grow, front end billing / charge entry may be expected as a job duty.
• AR Follow Up
  • Follow up on outstanding claims within insurance and patient AR until the outstanding claim has been resolved. Expectations are to resolve claims prior to timely filing, summarize claim issues, and work claims until resolution.
• Compliance and Regulations
  • Stay informed on federal, state, and local billing regulations, as well as payer-specific requirements.
  • Ensure adherence to compliance standards such as HIPAA and Medicare/Medicaid requirements.
  • Report any compliance concerns or irregularities to the appropriate team or leadership.
• Customer Service
  • Act as a liaison between patients, payers, and internal teams to address billing inquiries and resolve issues.
  • Provide exceptional service by explaining insurance benefits, payment responsibilities, and account balances to patients and families.
• Data Management
  • Maintain accurate and up-to-date records in the revenue cycle management system and electronic health record (EHR).
• Collaboration
  • Work closely with the Revenue Cycle Management team to identify areas for improvement and streamline processes.
  • Collaborate with IT and other departments to ensure technology solutions effectively support revenue cycle operations.

Core Competencies:

• Accountability: Demonstrates an understanding of the link between one's own job responsibilities and overall organizational goals and needs.
• Analytical Thinking: Demonstrates the ability to deconstruct information into smaller categories to draw conclusions.
• Result Oriented: Demonstrates knowledge in partnering with your supervisor for setting and achieving challenging goals.

Qualifications:

• 2+ years of full-time professional experience in a healthcare setting.
• Minimum 2 years of direct experience in revenue cycle management.
• Experience in behavioral health preferred.
• Proficiency with Microsoft Office and video conferencing technologies.
• Strong interpersonal skills when working with corporate partners in other departments for overarching company goals.
• Clear communication skills
• Flexible personality and able to overcome challenges and setbacks.
• Alignment with our company values of respect, relationships, empowerment, and excellence.