RCM AR Specialist

Role Description

The RCM AR Specialist follows up on Claim Denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports. They are assigned a specific book of business based on Financial Class and Payers, working to support the field related to claim denials.

Responsibilities Include, But Are Not Limited To, The Following:

Daily Duties

• Follows up on denied claims and no response within a timely manner.
• Submits appeals related to contract rate variances with a discrepancy in allowed amounts; notifies Supervisor of payers for which this is a consistent problem.
• Submits Medical Records when requested by the payer for claims processing determination.
• Monitors and reviews Payer correspondence from the lockbox and faxes.
• Monitors, reviews, and responds to Hub (field) communication inquiries within the 48-hour requirement.

Account Follow-Up

• Using data from the monthly aged accounts receivable report, calls payers or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system “notes”.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Responds to written and telephone inquiries from insurance companies.
• Builds and maintains relationships with personnel from assigned carriers.
• Meets with Pod Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow-up concerns.

Other

• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends all meetings as requested including regular staff meetings.
• Attends Medicare and other continuing education courses as requested. Pursues and participates in education to remain current with changes in the Healthcare industry.
• Performs any additional duties as requested by RCM Leadership.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards, and policies.

Qualifications

• High school diploma or GED equivalent, required.
• College education or trade school preferred.
• Previous Medical Billing and Collections experience preferred. Preference for those with a minimum of eighteen months experience.
• Comfortable using email and interacting with Internet applications.
• Knowledge of practice management and Microsoft processing software.
• Proven understanding of Explanation of Benefits forms, claim forms, and the insurance billing process.
• Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement.
• Basic knowledge of CPT and ICD-10 coding.
• Strong written and verbal communication skills.

Requirements

• Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds.
• Position requires prolonged sitting, some bending, stooping, and stretching.
• Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required.
• Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.
• Working conditions are a professional office environment. If remote, must have functioning internet and be open to on-camera team calls.
• Occasional evening or weekend work.

Benefits

• The salary range posted for this position is the national average; however, actual compensation may vary depending on geographic location, job-related knowledge, skills, and experience.