RCM AR Specialist

Description

POSITION:  RCM AR Specialist

RESPONSIBLE TO: RCM Supervisor, AR Collections

JOB SUMMARY:  Follows up on Claim Denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports.  RCM AR Specialist are assigned specific book of business based on Financial Class and Payers. Work to support the field related to claim denials.

RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:

Daily Duties

• Follows up on denied claims and no response within a timely manner.
• Submits appeals related to contract rate variances with a discrepancy in allowed amounts; notifies Supervisor of payers for which this is a consistent problem.
• Submit Medical Records when requested by the payer for claims processing determination.
• Monitor and review Payer correspondence from the lockbox and faxes.
• Monitor, review, and respond to Hub (field) communication inquiries within the 48-hour requirement.

Account Follow-Up

• Using data from the monthly aged accounts receivable report, calls payers or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system “notes”.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Responds to written and telephone inquiries from insurance companies.
• Builds and Maintain relationships with personnel from assigned carriers.
• Meets with Pod Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow up concerns.

OTHER

• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends all meetings as requested including regular staff meetings.
• Attends Medicare and other continuing education courses as requested.  Pursue and participate in education to remain current with changes in the Healthcare industry.
• Performs any additional duties as requested by RCM Leadership.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

SUPERVISORY RESPONSIBILITIES

This position has no supervisory responsibilities.

TYPICAL PHYSICAL DEMANDS

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds.  Position requires prolonged sitting, some bending, stooping, and stretching.  Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required.  Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.  Working conditions are a professional office environment.  If remote, must have functioning internet and are open to on-camera team calls. Occasional evening or weekend work.

Qualifications

EDUCATIONAL REQUIREMENTS:

• High school diploma or GED equivalent, required.
• College education or trade school preferred.

QUALIFICATIONS AND EXPERIENCE:

• Previous Medical Billing and Collections experience preferred.  Preference for those with a minimum of eighteen months experience.
• Comfortable using email and interacting with Internet applications.
• Knowledge of practice management and Microsoft processing software.
• Proven understanding of Explanation of Benefits forms, claim forms and the insurance billing process.
• Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement.
• Basic knowledge of CPT and ICD-10 coding.
• Strong written and verbal communication skills.