RCM Specialist (Part Time)

RCM Specialist (Part Time) Oversees pre-date of service revenue cycle and medical billingfunctions for the University's two locations in San Francisco andSacramento. Responsibilities include scheduling coordination,registration, insurance eligibility and benefits verification,payer participation, credentialing, authorizations, patientfinancial estimates, and collection of expected out-of-pocketamounts. Maintains a current payer matrix and applicable feeschedules and ensures patient responsibility is accuratelyidentified. Coordinates with the outsourced billing/RCM vendor andmonitors claims, A/R, denials, timely-filing risks, unworkedclaims, payments, and collections to ensure issues are identifiedand resolved. Serves as the primary liaison between the University,providers, patients, and the outsourced billing team. The positionis ideally based in San Francisco and requires regular travel toSacramento; as volume grows, the position may hire and manageadditional billing staff. Essential Functions Business Administration Coordinates surgery scheduling and registration processes and verifies that required insurance and patient information is complete before the date of service. Resolves patient financial questions and conflicts professionally, including explaining estimates, copays, coinsurance, deductibles, and separate professional and facility financial responsibility. Manages the relationship with the outsourced billing/RCM vendor; conducts regular RCM reviews and monitors claims, A/R, denials, timely filing, unworked claims, payments, and collection performance. Oversee pre-date of service patient collections and ensures collected amounts are accurately documented and communicated to the appropriate billing/finance team. Oversee physician credentialing, payer enrollment/participation, and maintenance of credentialing files and payer documentation. Coordinates scheduling and directs duties of business office staff as applicable. As volume grows, may recruit, hire, train, and manage additional billing staff. Monitors outsourced A/R and collections performance, including aging, denials, timely-filing risks, unworked claims, payments, and collectible A/R; escalates revenue leakage and unresolved issues. Professional Development Develops relationships with billing organizations, ASC state and local associations, and dental billing organizations to remain current on industry guidelines, payer requirements, and revenue cycle best practices. Attends at least one relevant industry conference, association meeting, or educational program annually to maintain current knowledge of ASC, dental, and revenue cycle trends Activities that Enhance the Image of the Facility May participate in activities that promote a healthy community. Demonstrates knowledge and professionalism with community and other organizational members. Provides timely response and resolution to client complaints. Communication Listens respectfully, gives feedback directly, honestly and talks with others to clarify differences. Effectively communicates and interacts with patients (using translation services when needed), their family, and other external and internal clients (including fellow employees) from diverse backgrounds. Quality Demonstrates a willingness to look at new ideas and work in a changing environment. Understands, verbalizes and participates in the quality improvement process. Supports initiatives designed to improve individual and organizational performance. Other duties as assigned. University of the Pacific recognizes that diversity, equity, and inclusion is foundational to the success of our valued students and employees. We prioritize policy and decision-making that demonstrates awareness of, and responsiveness to, the ways socio-cultural forces related to race, gender, ability, sexuality, socio-economic status, etc. impede or propel students, faculty and staff. Minimum Qualifications High school diploma or GED. Three (3) or more years of healthcare revenue cycle experience, preferably in an ASC, dental/oral surgery, or surgical setting. Experience with insurance verification, benefits investigation, prior authorization, credentialing, patient financial counseling, and healthcare collections. Preferred Qualifications ASC billing experience. Dental or oral surgery revenue cycle experience; experience working with both professional and facility billing is preferred. Able to read, write and communicate effectively with co-workers and patients. Flexible. Able to take directions from multiple sources. Displays a primary interest in serving the needs of the customer and maintaining standards of courtesy and friendliness to co-workers. Able to work independently, manage multiple priorities, and travel between the San Francisco and Sacramento locations as needed. Detail oriented and willing to flex hours to meet facility needs. Knowledge of insurance eligibility and benefits, payer requirements, prior authorization, credentialing, patient financial responsibility, and healthcare collections. Understanding of professional versus facility billing and common ASC revenue-cycle processes. Proficiency with Microsoft Office Suite and web-based payer portals. Knowledge of basic medical/dental terminology and strong attention to detail. Machines, Equipment, Work Aides: Computer, Microsoft Office Suite, copier, phones and shredder. Physical Requirements The physical demands described here are representative but not definitive of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work Environment/Work Week/Travel Work typically performed during standard business hours in person. Subject to busy clinical business environment requiring above average ability to prioritize and organize. Some overtime may be required. Hiring Range $36.93 per hour. We consider factors such as, but not limited to, scope and responsibilities of the position, candidate's qualifications, internal equity, as well as market and organizational considerations when extending an offer. Background Check Statement All applicants who receive a conditional offer of employment are required to execute a release and authorization for a background screening. AB 810 Misconduct Disclosure Requirement University of the Pacific complies with California Assembly Bill 810, requiring candidates accepting conditional job offers to disclose any final administrative or judicial findings, ongoing proceedings, allegations, resignations under investigation, or appeals related to sexual harassment or misconduct within the past seven years. #J-18808-Ljbffr University of the Pacific