RCM Collections Specialist III

Description

Position Summary: The Revenue Cycle Management (RCM) Collections Specialist III performs a wide variety of insurance billing duties in support of RCM services. As an integral part of our RCM team the position serves in a cross-functional, fast-paced environment in order to meet performance and quality assurance benchmarks. Essential duties include all aspects of insurance billing and collections.

Responsibilities:

Other duties as assigned

• Works directly with the insurance company, healthcare provider, and patient to get a claim processed and paid
• Reviews and appeals unpaid and denied claims
• Post appropriate adjustments based on client protocols and/or Explanation of Benefits (EOB).
• Know how to read and understand an EOB.
• Keep current on informational changes in billing/collections procedures
• Meet benchmarks for AR volume.
• Work invalid and rejected claims at clearinghouse.
• Handling collections on unpaid patient account balances.
• Answering patients’ billing questions.
• Phone triage & return patient phone calls.
• Work with outside collection companies based on client protocols.
• Post appropriate adjustments based on client protocols and/or Explanation of Benefits (EOB).
• Communicate/answer questions regarding outstanding AR issues
• Researching problems, testing, training and documenting best practices
• Work with team lead and client to set up AR process/protocols
• Assist team lead in setting benchmarks for AR management volume.

Qualifications

Education and Experience:

• Minimum 5 years of relevant experience of OR combination of degree from an accredited college and 2 year of experience

Qualifications:

• Systems application super user
• Excellent communication skills
• Ability to deal with a number of tasks simultaneously
• Strong attention to detail
• Basic or intermediate computer skills
• Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards.
• Must have the ability to exercise a high degree of diplomacy and tact; excellent customer services skills.
• Must be highly flexible; able to accommodate changing needs of the department.
• Must be a self-starter, motivated and have the ability to multi-task.
• Training and/or experience with computer data entry.
• Knowledge of medical terminology required.
• Ability to understand and follow instructions.