RCM Specialist - Collections

Overview

The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances.

Responsibilities

• Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.
• Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.
• Collaborate with internal teams to address claims challenges and improve revenue cycle.
• Escalate complex or uncollectible accounts to management for further action.
• Submit appeals / claim corrections as needed within timely filing limits.
• Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.
• Payer projects as assigned.
• Identify and report trends in claim denials and payment challenges.
• Communicate with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries.
• Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.
• Assist in the implementation of processes to measure, assess, and improve the performance of the RCM department activities of the company.
• Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement best practices in all departmental activities.
• Participate in surveys conducted by authorized inspection bodies as required.
• Participate in the company\'s Performance Improvement program as requested by the Performance Improvement team.
• Participate in company committees when requested.
• Participate in in-service education programs provided by the company.
• Pursue continuing education programs appropriate to the job.
• Perform other duties as assigned by management.
• Complete all mandatory and regulatory training programs.
• Report any misconduct, suspicious or unethical activities to Compliance.
• Complies with accepted professional standards and practice.

Qualifications

Educational Requirements

Experience

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