RCM Specialist

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RCM Specialist
Miami, FL, US

17 days ago Requisition ID: 1256

Full Time - Mon to Friday 9:00 a.m. - 5:00 p.m.

Position Summary
IN PERSON. The Revenue Cycle Management Specialist will coordinate the Authorizations and Referrals process between Agape and the Insurance plan. Responsible for the Pre‑Billing Reviews the Third‑party Billing Queues to locate claims that need to be edited or corrected to ensure claims are billed accurately.

Essential Duties and Responsibilities

Analyzes the patient record to determine legitimacy of admission, and treatment.

Reviews all Insurance coverage information to request prior authorization on a monthly basis from the Insurance within the established department turnaround time. Routinely communicates with clinical staff and supervisors on all authorization inquiries to reduce the occurrence of non‑authorized services.

Performs ongoing audits on Billing Queues to establish clean claim billing/adjudication.

Responsible for timely re‑submission and accuracy for billing claims.

Reviews claim elements as Credentialing, Authorizations, Coding, and making sure we are billing the correct Insurance. Research balances and takes necessary collection actions.

Collaborates and works cross‑functionally with departments to ensure pre‑billing is completed. Identifies, analyzes, and researches the root cause of denials and underpayments.

Staff is responsible for maintaining updated insurance information on all patients.

Collects copayments, deductibles, and other applicable balances from patients in person or by phone.

Identifies, analyzes, and researches the root cause of denials and underpayments.

Participates in the continuous quality improvement process.

Performs all other duties as assigned or required.

Assists the department in cross‑training existing staff and new hires.

Education and/or Experience

High school diploma or equivalent.

Familiar with Primary Care billing.

Billing reconciliation.

CPT Codes.

Benefits Highlights

Retirement: 403b plan.

Competitive vacation and sick plan, 12 paid holidays.

Leadership development, personal and professional growth.

Culture: Loved and faith‑based mission, respect for diversity; going through expansion and growth.

Who we are
We are a faith‑based non‑profit organization dedicated to restoring individuals and families to psychological, social, physical, and spiritual health. You will be working with a team of passionate professionals eager to provide you with the necessary tools and knowledge to succeed and build your career.

Our Mission
Restore individuals and families to psychological, social, physical, and spiritual health.

Agape Network is an Equal Opportunity Employer and a Drug‑Free Workplace.

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