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.

Communicateasneededwithpatients about billing issues,including theresults ofapplications for financial hardshipassistanceand other responses tocustomerinquiries about

Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.

Assist in the implementation of processesto measure,assess,and improve the performance of the RCM departmentactivities of thecompany.

Ensure ongoingcompliance with alllawsandregulations;ensurethat the department meets orexceedsaccreditation standards; and implement "best practices" in all departmental

Participate insurveysconductedby authorized inspection

Participate in the company's Performance Improvement program as requested by thePerformance Improvement

Participate incompany committees when

Participate in in-service education programsprovided by the company.

Pursuecontinuing education programs appropriateto job

Performotherduties as assigned by

Complete all mandatory and regulatory training programs.

Reportanymisconduct,suspicious orunethicalactivitiesto the Compliance

Complies with accepted professional standards and practice.

Qualifications

Job Skill Requirements :

Ability to read and interpret medical records for billing purposes.

Competent in mathematic equations.

Ability to compute unit conversions for drugs.

Understanding of CPT, HCPCS, ICD-10, and NDC codes

Diligent attention to detail.

Excellent verbal and written communication.

Understanding of HIPAA compliance.

Self-directed, has the ability to work with little supervision.

Proficiency in Excel, Outlook, and all other office applications.

Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)

Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.

Deep understanding of home infusion process, therapies, and related services.

Ability to understand payer explanation of benefits.

Educational Requirements :

• High school diploma or GED

Experience :

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Job Locations US-IL-Hoffman Estates

Posted Date 9 months ago (2 / 14 / 2025 12 : 06 PM)

Requisition ID 2025-13805

# of Openings 1

Category Accounting / Finance

Location : Location US-IL-Hoffman Estates