RCM - Claims Specialist

Position: RCM Claims Specialist

Reports To: RCM Team Lead

Classification: Non-Exempt/Full-Time

Location: Remote

JOB DESCRIPTION:

The Revenue Cycle Management Claim Specialist will be responsible for all aspects of the claim cycle. Will verify compliance and quality of all claims before submission, perform follow up on all rejected and denied claims ensuring timely correction and resubmission. Ensure timely and proper payment from all payers.

PRIMARY RESPONSIBILITIES:

• Daily insurance claim submission and follow-up.
• Responsible for working and posting claims of patients covered under private and public plans while posting appropriate updates and statuses in the RCM system.
• Work appeals/denials in a timely manner and creates solutions to prevent future denials.
• Research/process credits (recoupments and refunds) to insurance companies and patients as appropriate.
• Reviews and analyzes patient accounts to determine accurate levels of coding and other billable services.
• Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well.
• Understands and abides by CMS and other payer guidelines in coding and billing.
• Must be familiar with and remain updated on ICD-10, CPT codes, and medical terminology.
• Research coding and claims questions thoroughly in order to maintain high quality standards.
• Ensures appropriate modifiers are assigned when needed to claim.
• Able to utilize and leverage Microsoft Office products (PowerPoint, Excel, Word, Outlook)
• Communicate issues, concerns, and updates clearly, effectively, and frequently.
• Meets deadlines and productivity standards set by RCM Leadership.
• Any other duties and/ or special projects as assigned.

QUALIFICATIONS:

• Possesses the ability to work in a constantly changing environment, good judgment skills, and capable of making decisions with attention to detail.
• Must have excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy.
• Must have excellent analytical and problem-solving skills.
• Ability to work easily and cooperatively with other departments.
• Ability to work independently and follow through on tasks without direct supervision.
• Ability to work well under pressure in a flexible and expeditious manner.
• Must have experience with Microsoft Products and PMS systems, EMR systems, and clearing houses.

EXPERIENCE / EDUCATIONAL REQUIREMENTS:

Education:

Graduate of four-year high school or equivalent (GED).

Experience:

• 3 - 5 years: Three to five years healthcare RCM experience related to the described duties.
• Skills and Knowledge of EMR software functionality and operations.
• Proficiency in Microsoft Office Applications.