Offer summary

Qualifications:

Minimum of 5 years of experience in medical billing, finance, or accounting, preferably with insurance knowledge., Two years of college coursework or equivalent work experience., Strong organizational, time management, and problem-solving skills., Excellent verbal and written communication skills, with knowledge of email etiquette..

Key responsibilities:

Follow up on rejected claims and ensure timely resolution before claims reach 180 days.

Research and analyze historical data related to accounts receivable.

Perform adjustments, resubmissions, appeals, and credits on claims as needed.

Generate weekly reports on collection activities and claims status for leadership.

Job description

Department: Revenue Cycle Management

Position Title: Senior Medical Specialist

Reports to: Revenue Cycle Leadership

Job Function:

Resolution of all unresolved Portal and EDI assigned accounts receivable. Increase cash collection, ensuring all claims are submitted and/or resubmitted within the initial and total filing limit. Processing appeals as needed. Keeping open communication, troubleshoot and resolve open balances while managing a healthy relationship with our Clients and Payers.

Responsibilities:

Ensure all accounts with accounts receivables over 60 days have a pending resolution and/or resolution before claims reach the 180-day transactional RCM system date and/or filing limit
Follow up on all assigned Rejected claims within the RCM Clearing house
Understand and perform research of all historical data with accounts assigned to you
1. Make any adjustments, resubmittals, appeals and/or credits on claims for any given Client and/or Payer
2. Being confident to act when speaking to an account within Leadership guidelines to resolve past due balances and/or issues
3. Ensure all unapplied payments/credits on accounts are posted correctly prior to closing of Month End
4. Process Payer Changes and/or terminations within the Retention process
Assist with processing credit card and direct debit charges as needed
Communicate in a highly professional manner and nurture a healthy relationship with Clients and/or Payer accounts
Generate weekly reports to Leadership on collection activity, claims statuses such as payments, resubmitted claims, appeals, credits, and escalations needed etc.
Be able to support EDI Team with activities with file transactions
Coaching and training of existing and new staff members on-shore and off-shore
Understanding Medicare processes and RPM billing, cash posting and accounts receivables.
Maintaining contact with other departments to ensure effective and timely communication

Position Requirements:

5 years of billing, finance, or accounting experience (insurance preferred)
2 years of college coursework or equivalent work experience
Exceptional organizational and time management / prioritization skills
Skilled at problem-solving
Skilled at verbal and written communication, including knowledge of email etiquette
Basic knowledge of billing concepts such as reconciliation, posting, deposits, debits, and credits
Demonstrated attention to detail
Willingness to work as part of a collaborative team, but also independently accomplish tasks
Understand HIPAA and privacy regulations
Demonstrate ethical business practices

Required profile