RCM Consultant (Independent Contractor) - Remote - Nationwide

About the role

Serve as the primary point of contact with insurance carriers, independent physician networks (IPNs), and payer representatives regarding participation, reimbursement, and contract-related matters.

Responsibilities

• Verify patient insurance eligibility, benefits, prior authorization requirements, and estimated financial responsibility.
• Educate patients on insurance benefits, deductibles, co-payments, coinsurance, and outstanding balances.
• Review clinical documentation to support accurate coding and reimbursement, collaborating with providers to obtain documentation clarification when needed.
• Assign and review ICD-10, CPT, and HCPCS codes to ensure accurate and compliant coding.
• Prepare, submit, and monitor insurance claims while ensuring compliance with payer requirements and filing deadlines.
• Manage accounts receivable by following up on outstanding claims, communicating with payers, submitting documentation, and researching claim status.
• Post insurance payments, reconcile remittance advice, and process contractual adjustments.
• Investigate, appeal, and resolve denied, rejected, or underpaid claims.
• Generate patient statements, reconcile patient balances, and assist with account resolution.
• Coordinate collection activities and facilitate referrals to approved third-party collection agencies, when appropriate.
• Maintain compliance with all payer, regulatory, and organizational billing and coding standards.
• Prepare and analyze reports related to accounts receivable, denials, reimbursement trends, and revenue cycle performance.
• Optimize reimbursement and revenue collections.
• Reduce claim denials and aging accounts receivable.
• Ensure timely and accurate claim submission and follow-up.
• Support compliant coding and billing practices.
• Identify revenue cycle improvement opportunities and recommend process enhancements.
• Provide regular reporting and updates on revenue cycle performance metrics.

Community & culture

• Opportunities to engage with other Vitans through virtual meet-and-greets, events, and seminars.
• Monthly wellness events and programs such as yoga, HIIT classes, and more.
• Trainings to help support and advance your professional growth.
• Team building activities such as virtual scavenger hunts and holiday celebrations.
• Flexible work hours.
• Opportunities to attend Vituity community events including LGBTQ+ History, Día de los Muertos Celebration, Money Management/Money Relationship, and more.