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.




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