RCM Specialist

Job Summary:

The RCM Specialist plays a crucial role in ensuring the efficient and accurate processing of claims and patient accounts, contributing to the organization's financial health. They possess a comprehensive understanding of revenue cycle processes and demonstrate expertise in resolving complex claims and patient billing issues.

Essential Duties and Responsibilities:

• Lead and optimize the full revenue cycle process from billing the claim to final payment collection.
• Collaborate with the RCM team to maintain a clean and compliant revenue cycle.
• Generate claims accurately from EMR system to clearinghouse and monitor the claim following HRP standard protocol.
• Resubmit claims corrected as needed and communicate issues that need to be resolved.
• Communicate unbilled and billed claim holds to Team Leader or RCM Manager.
• Analyze and resolve complex claims denials and appeals.
• Investigate and address patient billing discrepancies and disputes.
• Identify and implement strategies to improve revenue cycle performance as needed.
• Collaborate with cross-functional teams to implement and manage assigned RCM accounts.
• Participate in revenue cycle audits and compliance reviews (quality review checks).
• Develop and maintain accurate and up-to-date documentation of all claims and patient accounts.
• Provide training and support to other RCM team members.

Key Performance Indicators (KPIs):

• Clean claim rate >95%
• Aged AR < 20% of total AR
• Meets productivity expectation of 45 non-Medicare claims per day or 75 Medicare
• Net collection rate of >95%
• Meets and passes 100% of quality review checks completed by RCM Manager

Qualifications:

• 3–5 years of experience in revenue cycle management or a related field
• Proficient in Microsoft Office Suite 365
• Proficient in home health and hospice electronic health records (EHR) systems
• Strong understanding of insurance billing and coding procedures
• Excellent communication, problem-solving, and analytical skills
• Ability to work independently and as part of a team
• Proven track record of success in resolving complex claims and patient billing issues

Benefits:

• Competitive salary and comprehensive benefits package, including health insurance, dental insurance, vision insurance, paid time off, and 401k savings plan
• Opportunity to work in a dynamic and growing healthcare organization
• Professional development and training opportunities
• Contribution to the organization's financial success and patient satisfaction