Senior RCM Specialist

Revenue Cycle Management Specialist are responsible for maintaining a timely revenue cycle for all the goods and

services provided by AdaptHealth. Also responsible for maintaining patient confidentiality and function within the

guidelines of HIPAA. Completes assigned compliance training and other educational programs as required. Maintains

compliant with AdaptHealth’s Compliance Program. 

Essential Functions and Job Responsibilities:

Account Receivable

• Ensure organization receives accurate payment for goods & services provided according to contracted rates and/or payer fee schedules. 
• Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites. 
• Reconcile the accounts receivable to ensure that all payments are accounted for and properly posted. 
• Investigate and resolve customer inquiries regarding charges.
• Monitor patient account details for non-payments, delayed payments, and other irregularities. 
• Communicate with customers regarding insurance, payments, and invoices. 
• Research and resolve payment discrepancies. 
• Identify and verify that billing complies with policies and procedures. 
• Identify trends and root causes related to inaccurate payments and escalate as appropriate. 

Authorization

• Analyze daily requests to determine coverage and approval utilizing criteria. 
• Utilize clinical staff for medial reviews when necessary. 
• Notify staff when authorization is approved or denied. 
• Obtain & enter authorization into database timely & accurately. 
• Collaborates with internal & external customers to provide status updates & coordinate appeals on denied authorization. 
• Resolves pending revenue by reconciling approved authorizations and pending charges. 

Confirmation

• Ensure order will bill correctly to insurance. 
• Ensure order has valid proof of delivery.
• Address messages on sales order
• Correct messages as needed.
• Process order to correct WIP state or confirm order. 

Data Support

• Responsible for the daily claims submissions/printing for all eligible/ready status claims
• Resolves all claim rejections in a timely manner to guarantee submission within the timely filing requirements of the payers.
• Identifies claim rejections and escalates as appropriate to facilitate educational opportunities or process improvements.
• Maintains daily, weekly, monthly system/database functions and performs routine functions as defined by leadership.

Unbilled Revenue

• Analyze documentation required for billing services and ensure compliance to payer requirements. 
• Resolve pending revenue by reconciling received documentation and pending charges. 
• Requests authorization from state Medicaid programs. 
• Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices. 
• Completes accurate documentation of authorization request and follow up activities on each account.
• Ensures proper payer and system follow up procedures are performed for accurate authorization tracking.
• Performs extensive account audits and ensures proper billing for services to the accurate payer. 
• Ensures proper revenue recognition for billed charges and services moving forward. 
• Completes all assigned requalification within the set 75-day time frame by having patients retested, picking up equipment when appropriate, or executing ABNs and setting patients up on autopay. 
• Investigate and resolve customer, patient, or physician office, concerns regarding questions while working with the patient through the requalification process. 
• Establish and maintain relationships with key individuals in the regions to support the requalification process setting clear expectations of what is required by the region.

Patient Financial Services

• Identify trends and root causes related to inaccurate private pay billing, and report to manager while resolving account errors. 
• Investigate escalated customer billing inquiries and take appropriate action to resolve the account.
• Resolve private pay charges for returned payments due returned payments. 
• Resolve accounts pertaining to patient account inaccuracies or patient demographics.
• Respond to Collection agency regarding patient disputes of balances owed on accounts.
• Enroll patients calling regarding financial responsibility and enroll in autopay.

RCM System (CPTM):

• Responsible for updating data elements that drive revenue generation and decrease denial rates. 
• Work collaboratively with RCM leadership to maximize RCM overall productivity.
• Adhere to frameworks and maintain documentation appropriately.
• Assume responsibility for independent completion of tasks and small projects.

All RCM Specialist responsibilities:

• Educate patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends. 
• Maintains an extensive knowledge of different types of payer coverage, insurance policies, payer guidelines and payer contracts ensure accurate billing and timely payment is received. 
• Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification.
• Collaborates with physician offices, AdaptHealth sales and support staff to ensure timely receipt of documentationas well as educating, as necessary. 
• Identify trends and providing feedback and education to internal and external customers on compliant documentation requirements for services provided. 
• Develop and maintain working knowledge of current HME products and services offered by the company.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth’s Compliance Program
• Performs other related duties as assigned.

Competency, Skills and Abilities:

• Decision Making 
• Analytical and problem-solving skills with attention to detail 
• Strong verbal and written communication 
• Excellent customer service skills 
• Proficient computer skills and knowledge of Microsoft Office 
• Ability to prioritize and manage multiple tasks. 
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction. 

Education and Experience Requirements:

• High School Diploma or equivalent
• One (1) year work related experience in health care administrative, financial, or insurance customer services, 
• claims, billing, call center or management regardless of industry. 
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.