RCM Billing Specialist

Responsibilities and Qualifications

• Respond to requests from management, staff, or providers in a timely and appropriate manner.
• Maintain patient and physician confidentiality and professionalism.
• Scrub claims daily and submit them to the clearinghouse.
• Generate timely submission of claims to assigned payers.
• Follow department policies and procedures to ensure accurate and timely claim resolution.
• Review and analyze A/R balances to ensure timely and accurate payments are received.
• Maintain accurate computer data and document all account activities in system applications.
• Follow up with insurance companies to resolve denials, corrected claims, and appealed claims.
• Bill coinsurance, deductibles, and patient responsibility accounts per payer guidelines.
• Review and respond to payer correspondence, including remittance advice, explanation of benefits, and denial letters.
• Document accounts clearly and concisely according to department procedures.
• Communicate by phone, email, and internal processes to resolve patient inquiries and insurance issues.
• Document billing and payment status for future follow-up and stay current on payer requirements.
• Answer patient billing questions and complete month-end reports and assigned service tickets.
• Review patient credits for resolution.
• Meet quality standards and participate in team meetings.

Qualifications

• Minimum of 1 year of medical insurance or healthcare billing and collections experience.
• Strong understanding of medical billing, collections, payment posting, revenue cycle, third-party payers, Medicare, Medicare Advantage, and payer regulations.
• Working knowledge of CPT and ICD-10 codes, procedural modifiers, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits, and appeal processes.
• Experience with billing software and electronic medical records; ECW experience preferred.
• Proficiency with PC and Microsoft Office applications, including Word, Excel, Outlook, and Teams.
• Strong attention to detail, organization, analytical ability, and problem-solving skills.
• Ability to work independently and as part of a team in a fast-paced environment.
• Strong written and verbal communication skills.