RCM, Billing & Collections Specialist

Summarized Job Description:

Responsible for accounts receivable follow-up, appeals, payer communications, denial

resolution, payment posting review, self-pay follow up, patient assistance program (PAP)

support, insurance verification, and claims processing to ensure timely reimbursement and

accurate billing. Follow up and collaborate with payers, patients, and corporate teams.

Primary Responsibility:

To ensure that all needed steps are completed in an accurate and timely manner to ensure timely billing for reimbursement of claims.

Reports directly to:

• RCM Billing & Collections Manager

Daily tasks:

• AR follow up, submit appeal, records, follow up with payer, making calls
• PAP follow up
• Escalating to corporate on billing, collection, posting, PAP, self pay issues
• Posting review, escalations to ensure timely posting
• Franchise payments to corporate
• Billing Holds
• Remit reviews
• Claims being sent next responsible party
• PBM claims within VS in Delivery Ticket WQ
• Bill nurse visits, track down nursing visits notes
• Patient billing questions
• Incoming and outgoing phone calls and faxes
• Verification of benefits, twice a week
• Audits
• Medical records
• Collect Plus – patient collections in stage 2

Weekly Tasks:

• Confirm accuracy of Checkwrite
• Ensure corporate is working Waystar rejections being worked timely
• Inquiry spreadsheets
• Franchise needs spreadsheet

Monthly Tasks:

• Adjustment reviews
• Cost refunds
• Review denial report
• Participate in one on one’s with direct report

As Needed Tasks:

• Participate in meetings as needed
• Complete all required training, competencies, and certificates on time
• Other tasks that are assigned by leadership
• Contracting issues

Work Location: Remote