Specialist, RCM

This Specialist will join the remittance posting team and be responsible for processing insurance company takeback requests, refunds, zero-pay remittances, and other tasks related to payment and remittance posting. The Revenue Cycle Management (RCM) team is looking for someone with insurance claims and/or remittance posting experience, plus critical thinking skills, attention to detail, and the ability to learn quickly and adapt to a changing environment.  

Education/Experience:          

• High School Diploma required
• Two years' experience in healthcare administration/revenue cycle
• CRCR Certification preferred

Skills:                                              

• Demonstrates excellent customer service
• Ability to convey empathy
• Strong problem-solving, problem-prevention, and decision-making skills
• Ability to manage and prioritize multiple tasks in a fast-paced environment
• Excellent oral and written communication skills
• Ability to maintain composure and restore calm in a stressful situation
• Uses good judgment and diplomacy when dealing with others
• Desire and ability to work in a team environment
• Computer proficient with the ability to learn multiple software applications
• Ability to work with minimal supervision

Primary Responsibilities:  The purpose of this position is to execute follow-up actions on insurance claims; expedite positive cash flow, maximize reimbursement, and resolve claims denials and issues with payers in the assigned area of the Revenue Cycle claims process.

Essential Functions:

• Help develop &maintain a corporate culture that supports the mission and values of Mayfield Clinic
• Follow up on submitted electronic & hard copy claims in an accurate, timely manner; submit appeals, make corrections to overturn denials, post payments, & process takeback requests as required.
• Make all necessary corrections to claims that do not pass billing edits/payer requirements & resubmit to payers.
• Contact payers regarding unpaid claims. Research and/or ensure that questions and requests for information are addressed in a timely & professional manner to ensure resolution & reimbursement.
• Ensure timely & accurate posting of remittance advice information & follow up as needed to ensure full, expected reimbursement for services provided.
• Maintain documentation and update our practice management system for appropriate claims submission & other pertinent information to identify action taken.
• Make necessary adjustments as appropriately required by plan reimbursement & company policy.
• Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
• Research & initiate requests for refunds for accounts with credit balances.
• Answer & initiate phone inquiries regarding bills, charges, claims, and account status.
• Update data in the practice management system as required.
• Contribute to the team environment by performing other duties as assigned.

Physical Requirements:

• Hand Movement, including repetitive motions, grasping, holding, and finger dexterity.  Reading, Writing, and Hand-Eye Coordination.  Vision, including color distinction, and visual inspection.  Hearing, talking, sitting, lifting up to 10 pounds, bending, reaching

Mayfield Clinic Mission:  To provide the best neurological care for our patients through:

• Superior clinical outcomes
• Compassionate patient care
• Education and research
• Innovation

Mayfield Clinic Values:  All associates who are affiliated with the Mayfield Clinic must agree to use these values as a basis for their employment, and recognize that they are part of the associate’s annual Performance Review and Development Plan:

• Integrity: We commit to honest and ethical behavior in all of our endeavors and interactions.
• Excellence:  We commit to the highest level of performance and continuous improvement.
• Respect:  We embrace the importance of all individuals & value their diverse backgrounds, skills & contributions.
• Compassion:  We commit to being compassionate and empathetic in all of our interactions.
• Collaboration:  We embrace teamwork, mentoring, cooperation, sharing of expertise, & empowerment.