MH
RCM Claims Resolution Specialist
- Hiring from
- United States
- Work type
- Remote
- Posted
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Job Title: RCM Claims Resolution Specialist
Reports To: Revenue Cycle Manager
Location: Dallas/Fort Worth - Remote
Job Summary:
RCM Claims Resolution Specialist with a minimum of five years of progressive healthcare AR/ Revenue Cycle experience with at least 3 years specifically in Behavioral health/ Substance Abuse denials, payer follow-up, and rebilling. Will manage a portfolio of assigned treatment centers and will be required to contact insurance companies for the purpose of claims processing in a timely manner. The Specialist is expected to work a minimum of 55 claims per day.
Duties will include telephone contact with insurance carriers as well as their payer portals for claims resolution. Additionally, be able to problem solve on next steps for claim denials. Various collection actions include claims resubmission, rejections, corrected claims, reviewing patient’s eligibility, and appeals. Accounts must be worked accurately in accordance with office standards. Queues need to be worked daily and in a timely manner. Adherence to HIPPA confidentiality is required. The role includes limited travel requirements, typically 1-2 times per year, for team training and departmental meetings.
Essential Functions:
- Understanding of Commercial, Medicare, Medicaid and third-party billing processes.
- Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other third-party payer requirements and systems.
- Effective communication abilities for phone contacts with insurance payers to resolve claims discrepancies.
- Documents all collection activity on accounts.
- Review explanation of benefits to ensure claims were paid correctly; based on fee schedule for payer.
- Problem-solving skills to research and resolve discrepancies, denials, appeals, collections. A calm manner and patience working with insurers during this process.
- Review claims for possibility of payment before closing out adjustments.
- Familiar with CPT and ICD-10 coding.
- Competent use of EMR and clearinghouse systems.
- Ability to work well in a team environment. Ability to escalate tasks, and handle conflict in a reasonable manner.
- Ability to multi-task.
- Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- Behavioral Health/ Substance Abuse experience required.
Physical:
- Frequently sitting at desk or computer while typing, completing paperwork, or meeting patients.
- Occasional extended hours during billing deadlines or high-volume periods.
Mental:
Position requires constant mental alertness, attention to detail, and high degree of accuracy required. Must be able to follow oral and written instructions and follow-through on all assignments. Must be able to work independently, problem solve and use sound judgment in resolving critical issues.