RCM Specialist – Collections

Overview:

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.

Qualifications:

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.