RCM Specialist

JOB SUMMARY

The Revenue Cycle Management Specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance payers. The RCM Specialist must possess critical thinking skills and an understanding of Medicare, Medicaid eligibility requirements as well as Commercial Insurance payer payment methods to correctly record contractual adjustments based on payer contracts or government regulations. In addition, the RCM specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

   ESSENTIAL JOB FUNCTIONS

• Responsible for charge and payment entry within Electronic Health Record.
• Responsible for correcting, completing, and processing claims for all payer codes.
• Analyze and interpret that claims are accurately sent to insurance companies.
• Perform follow-up with insurance companies on unpaid insurance accounts.
• Process appeals online or via paper submission.
• Assist in reconciling deposit and patient collections.
• Assist with billing audit related information>
• Process refund requests.
• Attend provider meetings/workshops when needed.
• Will attend supervision sessions as required.
• Will complete all other required trainings as assigned.

POSITION QUALIFICATIONS  

Minimum Qualifications:

• High School diploma or equivalent
• 3-5 years of experience specific to behavioral health billing
• Possess a thorough understanding OF BEHAVIORAL HEALTH CODES, AHCCCS, and have worked closely with insurance claims representatives in resolving claim issues.
• Knowledgeable in AHCCCS, Medicaid, CMS, guidelines and coding policies.
• Understanding of current coding and billing regulations and compliance requirements.
• Computer skills – EMR (KIPU specifically) and MS Office (Excel, Word, Outlook) to write and update notes and generate reports.
• Excellent Interpersonal and problem-solving skills.

Preferred Qualifications:

• Coding certificate
• Bachelor’s degree