Healthcare Collections Specialist - RCM

About the role

The Healthcare Collections Specialist - RCM will focus on resolving insurance claims from Medicare, Medicaid, and commercial plans that are underpaid or denied. They will use their payor knowledge and critical thinking skills to correctly identify denial root causes and effectively take action to get claims reprocessed and paid. The role requires a good grasp on professional billing to help vet the accuracy of claims billed and identify any billing or setup issues that may cause unclean claims. Responsibilities also include utilizing reconsiderations and appeals to accurately fight denied or underpaid claims.

Responsibilities

• Follow-up on outstanding claims with insurance companies through portals and phone calls.
• Research and resolve incorrectly processed claims.
• Determine root causes and establish trends across payors and/or sites.
• Utilize reconsiderations and appeals to accurately fight denied or underpaid claims.
• Understand other aspects of revenue cycle management (such as benefits, authorizations, billing) to identify any front-end errors and take steps to correct as needed.
• Perform core tasks and claim follow-up efficiently; meet production goals, quality standards, and team goals.
• Respond to all insurance and claim related correspondence timely.
• Perform other duties as assigned by supervisor.

Requirements

• Knowledge of CPT, HCPCS, and ICD-10 coding
• Expertise in health insurance claim denials
• Understanding payor requirements
• Previous medical billing and claims collection experience
• Ability to evaluate options and make efficient decisions
• Strong written and verbal communication skills
• Ability to read an EOB and understand denial reason codes
• Infusion background a plus

Qualifications

• Willingness to learn, be coached, and take accountability for self-improvement and growth
• Collaborative team player

Skills

• Knowledge of CPT, HCPCS, and ICD-10 coding
• Expertise in health insurance claim denials
• Understanding payor requirements
• Previous medical billing and claims collection experience
• Ability to evaluate options and make efficient decisions
• Strong written and verbal communication skills
• Ability to read an EOB and understand denial reason codes

Benefits

N/A

Pay

$24.00 - $34.00 per hour

Schedule

Hybrid - 3 days per week