RCM Specialist

Revenue Cycle Management Specialist

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/corrected to ensure claims are billed accurately. The Staff will assist in the resolution of outstanding accounts receivable problems from past due accounts. The Collections Staff is responsible for the collection of unpaid third-party claims and appeals, using various applications.
Essential Duties and Responsibilities:
Analyzes the patient record to determine legitimacy of admission, and treatment.
Reviews all Insurance coverage information to request prior authorization in the monthly bases 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.
Perform 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
Collaborate and work cross functionally with departments to ensure pre- billing is completed. Identify, analyze, and research the root cause of the denials and underpayments.
Staff is responsible to maintain updated insurance information on all patients
Collect co-payments, deductibles, and other applicable balances from patients in person or by phone
Identify, analyze, and research the root cause of the denials and underpayments.
Participates in the continuous quality improvement process.
Perform all other duties as assigned or required
Assist the department in cross training existing staff, and new hires.
Requirements:
High School diploma or equivalent.