RCM Adjustment Specialist

Description

Review prior postings of claims to determine insurance overadjustments or balances that may need to be transferred using Explanation of Benefits (EOB) documents and reports. RCM Adjustments Specialist are assigned specific books of business based on Financial Class and Payers. Work to support the field related to claim false credits.

Daily Duties

• Follows up on claims with credits balance to determine true or false credit within a timely manner
• Transfer (convey) balances to the appropriate payer or patient level per EOB or next financial responsibility.
• Monitor, review, and respond to Hub (field) communication inquiries within the 48 hour requirement.

Account Follow-Up

• Using data from the monthly aged accounts receivable report or daily credits reports, correct overadjustments to balance the claim.
• Builds and Maintain relationships with personnel from internal and external departments.
• Meets with Team Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow up concerns

Other

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends OSHA, HIPAA, and OIG training programs as required.
• Attends all meetings as requested including regular staff meetings.
• Attends Medicare and other continuing education courses as requested.  Pursue and participate in education to remain current with changes in the Healthcare industry.
• Performs any additional duties as requested by the CRO, RCM VP, and/or RCM Director. 
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.

Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

Qualifications

EDUCATIONAL REQUIREMENTS:

• High school diploma, or equivalent, required
• College education or trade school preferred

QUALIFICATIONS AND EXPERIENCE:

• Previous Medical Billing and Collections experience preferred. Preference for those with a minimum of eighteen months experience.
• Comfortable using email and interacting with Internet applications
• Knowledge of practice management and Microsoft processing software
• Proven understanding of Explanation of Benefits forms, claim forms and the insurance billing process
• Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
• Basic knowledge of CPT and ICD-10 coding
• Strong written and verbal communication skills