Specialist II, RCM (AR Denial Management)

Job Description :

The Specialist II, RCM AR role performs revenue cycle management activity audits for assigned insurance and patient accounts. The specialist assists client, colleagues and global partner teams with assignments and escalations related to their RCM department, while ensuring that that daily, weekly, and monthly tasks are accomplished effectively and in a timely manner, as well as assist with specific performance client-based initiatives. The Specialist will actively participate with researching and pulling the associated clinical and reimbursement guidelines / policies for the client's services and payer mix and articulate their findings to the primary team in verbal and written form, for the highest reimbursement outcome. The specialist monitors the quality of their global partner team's product and coordinates with the RCM subject matter experts to identify trends and reconcile opportunities.

• Complete inventory assignment(s) in a timely manner with minimal assistance and oversight.
• Aid with client-specific workflow process.
• Monitor work quality pertaining to client protocols, against audit tools and client and internal documented procedures.
• Actively participate in vendor management, global partner, and client meetings as requested by Management.
• Assist management with the preparation and documentation of the issues, trends, and other performance monitoring tools.
• Serve as a front-line back-up to ensure work processes continue to flow when global partners and / or assigned staff are not available.
• Develop and maintain positive working relationships and partner with internal and external customers, vendors and payers by providing superior customer service.
• Maintain the confidentiality of patient information in accordance with posting guidelines, company policy & procedure, and Health Insurance Portability and Accountability Act (HIPAA) regulations.
• Actively engage management with on-going client specific feedback to help prepare for Client Management meetings.
• Lead department and client-specific projects with small scope as assigned.
• Generate standard / ad hoc reports as needed, create action plans, and contribute to development of Standard Operating Procedures (SOPs).
• Perform other duties that support the overall objective of the position.

Department-specific responsibilities :

Claims

Coding

Credentialing

Insurance AR

Patient Services

Payments

Education Required :

Experience Required :

License / Certification Required :

Knowledge, Skills & Abilities :

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the company reserves the right to change this job description and / or assign tasks for the employee to perform, as the company may deem appropriate.

NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.