RCM Claims Specialist (Palliative Care) Position Available In Duval, Florida

RCM Claims Specialist (Palliative Care) Alivia Care – 3.0

Jacksonville, FL Job Details Full-time Estimated:

$41.1K – $49.9K a year 1 day ago Qualifications Medicare Accounting software Mid-level Windows 3 years Medical billing Data entry EMR systems Communication skills CHPC Full Job Description Jacksonville, FL 32257 Under the direction of the Director of Revenue Cycle Management handles incoming mail for palliative care, claims issues via the claims issue log and aging within Insync.

Primary Responsibilities:

Open, review, and distribute all incoming Palliative Care mail which includes incoming checks for deposit to ASC and CPC. Reviews daily claims issue log to identify, correct and resubmit claims denials. This may require reviewing patient demographic information and making phone calls to applicable insurance companies for Insurance eligibility verification. Respond promptly and within no more than five (5) business days to any requests for response or follow up sent by RCM Insync team. Provide RCM Company with all documentation received from payers, including, but not limited to explanations of benefits, payer newsletters, pre-existing questionnaires, using the storage and notification methods specified by the RCM. Pull updated face sheets from various hospital EMR systems to ensure patient data is up to date for claims correction. Reviews all alerts/task messages received from the RCM team or any errors/items that require review for possible correction by provider. Acts as a resource for RCM third party claims to provide feedback on any questions or processes, in reference to how to handle/correct denied claims and payments being applied in accordance with company policy using the Reasonable and Customary rates. Coordinate with applicable staff on a regular basis to report on payer or provider contract, and system issues. Identify and track billing issues with ERA’s received to ensure proper resolution and posting. Proactive identification of solutions to improve the overall effectiveness and efficiency of the department for process improvement scenarios for incoming or existing tasks. Assist RCM Supervisor by reviewing incoming remits and adding any applicable secondary payer information. Receives and handles all communications regarding standard patient pay statement calls including general statement questions, disputes or overdue payments. Furnish and/or assist RCM with assisting obtaining access to payer websites. Attends the weekly conference call with RCM to discuss the standard financial reports or any billing related issues. Must complete all the RCM Services training provided. Responsible for complying with all applicable (federal and state) laws and regulations as well as CHPC contractual agreements related to the submission of claims for practitioner services. May act as back up from some duties of the CPC RCM Supervisor. Maintain and follow company policy for collections and refunds. Complete special projects and other duties as assigned by management.

Required Licenses/Certifications:

Qualifications:

Education/Experience:

Any combination of education and experience that would provide required skills and knowledge for successful performance would be qualifying. Typical qualifications would be equivalent to: Minimum three (3) years experience as a medical biller or similar role in a (Professional) Healthcare setting. Experience with Windows, accounting software and data entry. Working with medical payers including, Medicare Medicaid, and commercial insurance.

Knowledge of:

Medical Billing software and electronic medical records. Insurance verification process and authorization requirements. Insurance reimbursement guidelines including HMO/PPO, Medicare, Medicaid and other payer requirements and systems. Revenue cycle and how the various components work together preferred.

Skilled at:

Excellent written and verbal communication skills Multitask and manage time effectively. Ability to work independently and with minimum supervision.

Physical Requirements/Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable Individuals with disabilities to perform essential functions. Office environment with little to no lifting Extensive use of computer Moderate use of phone We are an equal opportunity employer. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, disability, pregnancy, genetic information, gender, sexual orientation, veteran status, or any other status protected under federal, state, or local law.