RCM Specialist

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At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives – out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients’ lives, please click to apply, we would love to hear from you.

RCM Specialist

This position is responsible for maintaining a timely revenue cycle and ensures accurate payment for goods and services according to contracted rates and/or payor fee schedules. Also responsible for maintaining patient confidentiality and function within the guidelines of HIPAA.

Job Duties:

Accounts Receivable:

• Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites.
• 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.

Authorization and Confirmation:

• Collaborates with internal & external customers to provide status updates & coordinate appeals on denied authorization.
• Resolves pending revenue by reconciling approved authorizations and pending charges.
• Ensure orders will bill correctly to insurance.

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.

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.

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.
• Respond to Collection agency regarding patient disputes of balances owed on accounts.

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.
• Performs other related duties as assigned.

Competency, Skills and Abilities:

• 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.

Minimum Job Qualifications:

• 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.
• 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.

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.