Revenue Cycle Management Specialist (full cycle)

Below is a list of duties required of this position.

Extensive Centricity Software experience is a must. Please list on resume if you have this experience.

The Revenue Cycle Management (RCM) Specialist will be knowledgeable in all areas of the revenue cycle. This person must be a good communicator, have attention to detail, self-driven and managed, a team player with a positive attitude, and able to parse out time to accomplish all of the tasks each day. Below is a list of tasks that are assigned to the RCM Specialist:

1. Accounts Receivable Management
a. Unpaid claims follow-up with insurance carriers.
b. Telephone contact with insurance carriers for follow-up.
c. Appeal letters.
d. Knowledge of carrier specific billing requirements.
e. Secondary claims.
f. Document all action taken on an account in the appropriate area in the software system.

2. Patient Accounts Receivable Management
a. Delinquency calls to patients.
b. Delinquency letters to patients.
c. Determine accounts for collection agency.
d. Process accounts for collection agency.

3. Claims Submission
a. Run daily all primary and secondary insurance claims.
b. Attach documentation to appropriate claim forms.
c. Attach appropriate primary explanation of benefits to secondary claim form.
d. Stuff and mail claims to insurance carriers.
e. Run electronic claims.
f. Follow-up on denied claims on electronic report.
g. Follow-up on mail confirmation report.

4. Posting Payments
a. Post all insurance explanation of benefits.
b. Balance daily payments.
c. Knowledge of allowed amounts by contract.
d. Make appropriate adjustments according to contract.
e. Post all patient revenue.
f. Follow-up on all unpaid explanation of benefits.
g. Correct charges and re-bill when appropriate.


5. Posting Charges
a. Charge entry including posting co-pays.
b. Confirm accuracy of patient billing information in computer.
c. Balance daily charges.
d. Knowledge of appropriate coding practices.

6. Eligibility Verifications
a. Verify patient information and benefits with carriers.
b. Verify patients’ coverage on all primary and secondary payers.
c. Interview patients and complete paperwork.
d. Update the billing system with new and updated benefits.
e. Complete appropriate criteria sheets and authorization forms.
f. Communicate with payers.
g. Resolve potential problems with coverage.
h. Refer complicated issues to a supervisor.

8.. ERA
a. Run daily electronic remittance advice.
b. Post the daily electronic remittance advice.
c. Correct any denied or downcoded claims.
d. Appeal inappropriately denied services.

10. Communication
a. Must be a good communicator in English and able to document as such in the software

11. Goals
a. Must be able to meet designed KPIs for the team

Please send a resume listing relevant experience and needed software knowledge.