Revenue Cycle Management Specialist (RCM) I Supports and adheres to the Center for Vascular Medicine’s Code of Ethics and Business Standards. Demonstrates an understanding of patient confidentiality to protect the patient and clinic/corporation. Provides benefits verification and prior authorizations for all Cath lab procedures. Under direct supervision, assists with RCM related functions such as maintain medical records, patient accounts, and billing related queries.
Core Responsibilities:
- Obtain insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
- Provide cost estimates to patients and assess patient’s ability to meet payment requirements and discusses payment arrangements.
- Prints, mails, and/or faxes patient chart information as requested and authorized. Documents all processes.
- Releases medical records information to persons or agencies according to State and Federal regulations.
- Record information about the patient’s financial status and status of collection efforts
- Monitor overdue accounts and arrange debt repayment plans, based on each patient’s financial situation.
- Post payment receipts received into the practice management system and prepare bank deposit for the Revenue Cycle Supervisor.
- Investigate credit balance accounts and take appropriate action.
- Follow up with third-party payers that have failed to make appropriate payments with follow up correspondence and document activities and contacts in the practice management system
- Determine the reasons for non-payment of claims. Collect information and provide necessary documentation to insurance carriers by writing medical necessity letters or appeals to support payment of denied claims.
- Identify any issues or problems with payers and the possible difficulties in presenting clean claims to them based upon verification requirements.
- Other duties as requested or assigned.
Required Education/Experience:
- High school diploma or equivalent required.
- 3 + years’ experience, preferably in a medical office setting.
- Previous medical billing experience including insurance benefit verification and extensive knowledge of different types of coverage and policies.
- 3 + years’ experience in health-care billing & collection practices.
- Knowledge of electronic health record systems.
- Time Management, Organization, Attention to Detail and Quality Focus skills needed.
Required Qualifications/Skills:
- Willingness to engage in repeated follow up, to obtain necessary documents or signatures.
- Good oral and written communication skills, including good telephone skills (required)
- Detail oriented, organized decision maker.
- Ability to work independently and in a team environment.
- Ability and comfort in counseling patients regarding alternatives should they be unable to pay for services.
- Ability and comfort with collecting amounts due from patients.
- Payer claim denials & appeals: 3 years (Required).
- Analyzing Payer trends: 1 year (preferred).