The Revenue Cycle Specialist II, RCM is a position that calculates and posts receipts to appropriate accounts, verifies details of transactions; performs billing, posting and collection of claims related to specific payers. In this role, you will report to a Manager of Revenue Cycle Management.
Sort incoming mail daily and distributes mail accordingly
Scans and saves checks, remits and billing documents to correct locations
Monitors held billing and coordinate resolution of all issues
Researches, resolves, and prepares claims that have not passed the payer edits daily
Changes payer and rebills in EMR
Understands and follows up on claim denials and ability to follow up on denials
Assists with appeals
Submits of waiver requests as needed
Enrolls with payers for EFT/ERA submissions
Ensures the coordination of claim activities and designated agencies, and the timely reimbursement of receivables
Reviews and bills all secondary and tertiary insurances to correct charges, bill forms and supporting documentation (EOBs)
Achieves and maintains net collections and outstanding receivables goals as defined by company objectives
Identifies trends related to denials/coding and delinquent claims and communicate effectively with client manager for feedback to the client
Identifies system/payer issues such as rates, codes, set up and coordinate accordingly
Reports status of accounts and issues to appropriate supervisors and departments – maintains full transparency of accounts at all times
Follows requirements through the full cycle until accounts are satisfied, including patient collections and appeals
Documents, processes and coordinates all write offs and adjustments as needed
Works with contracting team and management to resolve payer issues
Works with branches for all questions on accounts
Troubleshoots system issues and work to resolve issues
Completes Provider enrollments for EFTs/ERAs
Responsible for ongoing process improvement
Coordinates coverage and cross training for the team
Attends regular meetings with teams and management to ensure open communication
Ongoing training and mentorship with team
Sets up payers in EMR and tests/tracks setup to ensure accuracy
Handles critical accounts and projects, coordinating with management, operations, and payers to ensure issues are resolved
Leads AR meetings with management, branches and staff as required
Other responsibilities as assigned
Excellent verbal, written and computer communication skills
Able to communicate across all levels of authority within company
Excellent organization, problem solving, and project/time management skills
Able to work with multiple teams within the organization to promote viable, ethical, and cost-effective solutions
Proven track record of successful collections
Able to effectively deal with change
Able to complete projects within specific timetables
Able to successfully interact with people in face-to-face situations as well as by telephone in a professional and effective manner