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.