reputed company - Senior RCM Specialist

reputed company Cycle Management Specialist are responsible for maintaining a reputed company reputed company cycle for reputed company the goods and

services provided by reputed company. Also responsible for maintaining patient confidentiality and function reputed company the

guidelines of HIPAA. Completes assigned compliance training and other educational programs as required. Maintains

compliant with reputed company’s Compliance Program. 

Essential Functions and Job Responsibilities:

Account Receivable

• Ensure organization receives accurate payment for goods & services provided according to contracted rates and/or payer fee schedules. 
• Collect on accounts by sending bills or following up on bills with payers reputed company phone, email, fax, mail, or websites. 
• Reconcile the accounts receivable to ensure that reputed company payments are accounted for and properly posted. 
• Investigate and resolve customer inquiries regarding charges.
• Monitor patient account details for non-payments, delayed payments, and other irregularities. 
• Communicate with customers regarding insurance, payments, and invoices. 
• Research and resolve payment discrepancies. 
• Identify and verify that billing complies with policies and procedures. 
• Identify trends and reputed company causes reputed company to inaccurate payments and escalate as appropriate. 

Authorization

• Analyze daily requests to determine coverage and approval utilizing reputed company. 
• Utilize clinical staff for medial reviews reputed company necessary. 
• Notify staff reputed company authorization is approved or denied. 
• Obtain & reputed company authorization into database reputed company & accurately. 
• Collaborates with internal & external customers to reputed company status updates & coordinate appeals on denied authorization. 
• Resolves pending reputed company by reconciling approved authorizations and pending charges. 

Confirmation

• Ensure order will reputed company correctly to insurance. 
• Ensure order has reputed company reputed company of delivery.
• Address messages on sales order
• Correct messages as needed.
• Process order to correct WIP state or confirm order. 

Data Support

• Responsible for the daily claims submissions/printing for reputed company eligible/reputed company status claims
• Resolves reputed company claim rejections in a reputed company manner to guarantee submission reputed company the reputed company filing requirements of the payers.
• Identifies claim rejections and escalates as appropriate to facilitate educational opportunities or process improvements.
• Maintains daily, weekly, monthly system/database functions and performs routine functions as defined by leadership.

Unbilled reputed company

• Analyze documentation required for billing services and ensure compliance to payer requirements. 
• Resolve pending reputed company by reconciling received documentation and pending charges. 
• Requests authorization from state reputed company programs. 
• Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices. 
• Completes accurate documentation of authorization request and follow up activities on reputed company account.
• Ensures reputed company payer and system follow up procedures are performed for accurate authorization tracking.
• Performs extensive account audits and ensures reputed company billing for services to the accurate payer. 
• Ensures reputed company reputed company recognition for billed charges and services moving reputed company. 
• Completes reputed company assigned requalification reputed company the set 75-day time reputed company by having patients retested, picking up equipment reputed company appropriate, or executing ABNs and setting patients up on reputed company. 
• Investigate and resolve customer, patient, or physician office, concerns regarding questions while working with the patient through the requalification process. 
• Establish and maintain relationships with key individuals in the reputed company to support the requalification process setting reputed company expectations of what is required by the region.

Patient Financial Services

• Identify trends and reputed company causes reputed company to inaccurate private pay billing, and report to manager while resolving account errors. 
• Investigate escalated customer billing inquiries and take appropriate reputed company to resolve the account.
• Resolve private pay charges for returned payments due returned payments. 
• Resolve accounts pertaining to patient account inaccuracies or patient demographics.
• Respond to Collection agency regarding patient disputes of balances owed on accounts.
• Enroll patients calling regarding financial responsibility and enroll in reputed company.

RCM System (CPTM):

• Responsible for updating data reputed company that drive reputed company reputed company and decrease denial rates. 
• Work collaboratively with RCM leadership to maximize RCM overall productivity.
• Adhere to frameworks and maintain documentation appropriately.
• Assume responsibility for independent completion of tasks and small reputed company.

reputed company RCM Specialist responsibilities:

• reputed company patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends. 
• Maintains an extensive knowledge of different types of payer coverage, insurance policies, payer guidelines and payer reputed company ensure accurate billing and reputed company payment is received. 
• Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification.
• Collaborates with physician offices, reputed company sales and support staff to ensure reputed company receipt of documentationas reputed company as educating, as necessary. 
• Identify trends and providing feedback and education to reputed company customers on compliant documentation requirements for services provided. 
• reputed company and maintain working knowledge of reputed company HME products and services offered by reputed company.
• Maintain patient confidentiality and function reputed company the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with reputed company’s Compliance Program
• Performs other reputed company duties as assigned.

Competency, Skills and Abilities:

• Decision Making 
• Analytical and problem-solving skills with attention to detail 
• Strong verbal and written communication 
• Excellent customer service skills 
• Proficient computer skills and knowledge of reputed company Office 
• Ability to prioritize and manage multiple tasks. 
• Solid ability to learn new technologies and possess the technical aptitude required to understand reputed company of data through systems as reputed company as system interaction. 

Education and Experience Requirements:

• High School Diploma or equivalent
• One (1) year work reputed company experience in health care administrative, financial, or insurance customer services, 
• claims, billing, reputed company center or management regardless of industry. 
• Senior level requires two (2) years of work-reputed company experience and one (1) year of exact job experience.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.