RCM Specialist

Responsibilities

• Review client accounts for accuracy and completeness.
• Obtain missing information and submit claims to insurance companies and other payer sources for payment.
• Identify insurance company or correct guarantor (client) to be billed; identify and bill primary, secondary, or tertiary insurances.
• Utilize a combination of client electronic health record and paper records to assist with billing and collections.
• Maintain accurate and legally compliant health record.
• Review insurance payments for accuracy and compliance with contract discounts.
• Identify and address insurance denials or partially paid claims and work with involved parties to resolve discrepancies.
• Manage assigned accounts ensuring outstanding/pending claims are paid in a timely manner and contact appropriate parties to collect payment.
• Communicate with health care providers, patients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.
• Solve billing and collection questions and issues by consulting supervisor, team members, and appropriate resources.
• Prepare reports and forms as directed and in accordance with established policies.

Requirements

• Must have received or be willing to receive the COVID-19 vaccination by the date of hire to be considered.
• Proof of vaccination required.
• High school diploma or equivalent.
• Bachelor’s Degree in Business Administration, Accounting, or Health Care Administration preferred.
• Minimum 3 years of experience in the healthcare industry (particularly, working with Medicaid and Managed Medicaid insurance companies).
• Medical billing, medical coding, medical administration certificate, or diploma program highly preferred.
• One to three years of training and experience in Revenue Cycle functions highly preferred.
• Compliant with HIPAA regulations.
• Understanding of medical terminology and strict confidentiality of patient and client information.
• Experience with CareLogic system preferred.
• Strong understanding of Microsoft applications; i.e. Excel, Outlook, Word, PowerPoint.
• Excellent and professional customer service to internal and external customers.

Qualifications

• Must have received or be willing to receive the COVID-19 vaccination by the date of hire to be considered.
• Proof of vaccination required.
• High school diploma or equivalent.
• Bachelor’s Degree in Business Administration, Accounting, or Health Care Administration preferred.
• Minimum 3 years of experience in the healthcare industry (particularly, working with Medicaid and Managed Medicaid insurance companies).
• Medical billing, medical coding, medical administration certificate, or diploma program highly preferred.
• One to three years of training and experience in Revenue Cycle functions highly preferred.
• Compliant with HIPAA regulations.
• Understanding of medical terminology and strict confidentiality of patient and client information.
• Experience with CareLogic system preferred.
• Strong understanding of Microsoft applications; i.e. Excel, Outlook, Word, PowerPoint.
• Excellent and professional customer service to internal and external customers.

Skills

• Microsoft applications (Excel, Outlook, Word, PowerPoint).
• Customer service skills.
• Medical terminology.
• Confidentiality of patient and client information.
• Medicare and Medicaid billing and coding.
• Electronic health records.
• Insurance claims processing.
• Microsoft applications (Excel, Outlook, Word, PowerPoint).
• Customer service skills.
• Medical terminology.
• Confidentiality of patient and client information.
• Medicare and Medicaid billing and coding.
• Electronic health records.
• Insurance claims processing.

Benefits

• FREE Virtual Primary Care, Urgent Care, and Mental Health Counseling for ALL Employees.
• PAID Maternity/Paternity leave.
• Medical Insurance (BCBS of IL).
• Dental Insurance.
• Vision Insurance.
• Life Insurance.
• Long-Term & Short-Term Disability.
• Pet Insurance.
• FSA (Health, Dependent Care, Transit).
• Telemedicine.
• EAP.
• 403(b) Retirement Plan with Employer Match.