Specialist I, RCM

Job Description:

The Specialist I, RCM performs revenue cycle management activities for assigned patient and insurance accounts. The incumbent assists colleagues and global partner teams with assignments and escalations related to their RCM department, while ensuring that that daily, weekly and monthly tasks are accomplished effectively and in a timely manner. This role will also assist and actively participate with specific performance client-based initiatives. They will also monitor the quality of global partner team work product and coordinate with the RCM subject matter experts to identify trends and opportunities.

• Complete inventory assignment(s) in a timely manner with minimal assistance and oversight.
• Aid with client-specific workflow process.
• Monitor work quality pertaining to client protocols, against audit tools and client and internal documented procedures.
• Actively participate in vendor management, global partner, and client meetings as requested by Management.
• Assist management with the preparation and documentation of the issues, trends, and other performance monitoring tools.
• Serve as a front-line back-up to ensure work processes continue to flow when global partners and/or assigned staff are not available.
• Develop and maintain positive working relationships and partner with internal and external customers, vendors and payers by providing superior customer service.
• Maintain the confidentiality of patient information in accordance with posting guidelines, company policy & procedure, and Health Insurance Portability and Accountability Act (HIPAA) regulations.
• Provide management with on-going client specific feedback to help prepare for Client Management meetings.
• Contribute/complete department and client-specific projects as assigned.
• Generate standard/ad hoc reports as needed, contribute to action plans and to the development of Standard Operating Procedures (SOPs).
• Perform other duties that support the overall objective of the position.

Department-specific responsibilities:

Insurance AR

• Review and/or audit accounts to determine status and appropriate action required.
• Research and follow-up on denials and requests for additional information.
• Receive, research, and respond to correspondence from insurance companies, attorneys, and patients.
• Use facility correspondence websites, phone, and/or correspondence to contact payers regarding reimbursement for unpaid accounts.
• Identify, verify, and document account adjustments according to established policies and procedures.
• Collaborate with management to identify payer trends and non-payment issues.

Education Required:  

• High School Diploma or General Educational Development (GED).
• Or, any combination of education and experience which would provide the required qualifications for the position.

Experience Required:

• 1+ years of experience in medical billing and/or collections in a healthcare or insurance environment.
   

License/Certification Required:

• Certified Coding Specialist (CCS-P), Certified Professional Coder (CPC), or Certified Coding Associate (CCA), required from AHIMA or AAPC; or licensure equivalent.

Knowledge, Skills & Abilities:

• Knowledge of: Healthcare carriers and payer requirements. Microsoft Office Suite (Word, Excel, Outlook and PowerPoint) with intermediate skill level. Windows based programs. Practice management software.
• Skill in: Effective communication with cross-functional team members, peers, and management; providing customer service to internal and external clients; problem solving, analytical, and critical thinking; working as member of a team; communicating clearly, concisely, and effectively; establishing and maintaining effective working relationships.
• Ability to: Build strong internal and external relationships; work independently with limited direction and/or guidance; maintain confidential information; work in a fast-paced environment; stay organized, prioritize workload, multi-task, and meet deadlines.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the company reserves the right to change this job description and/or assign tasks for the employee to perform, as the company may deem appropriate.

NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.