RCM AR Specialist

JOB SUMMARY

Responsible for the overall recovery and management of accounts receivable as it relates to maximizing accounts receivable collections for RCMS clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of appeals and responses to efficiently interact with insurance carriers and resolve the claim. Supports the RCMS BU's overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and achieving KPI results.

No budget responsibilities, but must meet established RCM KPI's.

This is a hybrid position, 2 days a week in office

ESSENTIAL FUNCTIONS/MAJOR JOB RESPONSIBILITIES

• Strong customer service skills for client satisfaction and client AR health answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for information
  • Timely management of unpaid claims as assigned, through the use of the client’s office management/administrator;
    aging reports; correspondence; Clearinghouse and PM rejections; SharePoint reference/maintenance
• Effectively handle complex payer denials; responsible to ensure that secondary claims are processed and paid. Monitoring and reconciliation of claims to include:
  • Held vouchers
  • Unbilled vouchers
  • Denial trends
  • Patient balance report
  • Credits and refunds
• Manage and track information requests to client.
• Answer and resolve all incoming calls and requests in a timely manner.
• Complies with and enforces policies and procedures
• Achieves goals set forth by RCM management regarding error-free work, transactions, processes, productivity and compliance requirements. Specific goals include 1,400 accounts worked per month
• May act as partner for new hires to assist them in learning
• Other duties as assigned

JOB REQUIREMENTS

Required

• 1+ year relevant work experience
• Prior experience on Allscripts PM (preferred)

Knowledge, Skills and Abilities

• Extensive knowledge with email, search engines, Internet
• Ability to effectively use payer website and Laserfiche; basic competence in use of Microsoft products
• Preferred experience with MS Access and PowerPoint, Crystal reports
• Experience with various billing systems, such as NextGen, Pro, Allscripts, Epic and others
• Knowledge of CPT, ICD10 and modifiers.
• Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
• Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers

Working Arrangements

• Standard work week or as defined by assignment requirements
• Primarily works in standard office environment or remotely
• May require after-hours, on-call support and/or holidays
• On-call and after hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needs

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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About Veradigm

Welcome to Veradigm, where our Mission is transforming health, insightfully. Join the Veradigm team and help solve many of today’s healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve. At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions of people.