About Pediatrica Health Group Inc. Every day is a good day to prepare for a healthy tomorrow. Providing children and their families with equitable access to quality pediatric care to build a foundation for a lifetime of optimal health and wellness is what drives our team to deliver its best every day. It's our purpose. Offering focused care from tots to teens, our pediatric primary care providers and teams partner with families to foster good health and strong, thriving communities. Second-to-none medical staff and top-tier administrative professionals keep our practices running smoothly and make each patient experience the best we can offer. Working in partnership with patients, families, and communities who put their trust in us for their care, we hold ourselves accountable to ensure equitable access to care, advocate to create impactful change, and continually learn and progress to create better outcomes and brighter futures. Together, we're paving the way for kids to develop into healthy young adults. Rooted in these values , we continue to grow and serve. Are you ready to join us?

POSITION SUMMARY

The RCM Administrator, a key position in the revenue cycle, manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries. The incumbent will assist in the clarification and development of process improvements and inquiries, assure payment for services rendered are recorded, reconciled timely, and posted accurately.

DUTIES RESPONSIBILTIES BILLING AND CLAIMS

• Prepares and submits clean claims to third party payers either electronically or on paper.
• Properly attends to all clearinghouse reports to clear rejections accurately
• Ensures all eligibility rejections are properly researched and corrected.
• Attends to all requirements for secondary billing protocols.
• Submits resubmissions, evaluating root cause and escalating any trends.
• Communicates effectively with each practice regarding insurance issues.
• Alerts practice staff of open balances by properly documenting in eClinicalWorks.
• Identifies and resolves all billing problems, keeping management informed.
• Uses the alert system in eClinicalWorks to communicate any coding errors.
• Maintains the strictest confidentiality, adhering to all HIPAA regulations.

COLLECTIONS

• Follows collection protocols for assigned accounts (follow up metrics, etc.)
• Maintains worklist ensuring each patient account has been reviewed timely.
• Monitors payments, accessing payor portals regularly for claim status.
• Follows third party rules regarding balance billing.
• Identifies denials, determines root cause, performs appeals.
• Escalates trendy denials to management for further research.
• Provides information to management regarding uncollectable account balances.
• Adheres to KPI metrics for Collection percentages, AR aging, Denial Management, etc.
• Reviews ERA's and EOB's as necessary, reporting posting errors to management.

OTHER:

• Actively participates in department staff meetings.
• Keeps abreast of changes in payor regulations and updates.
• Follows departmental Policy and Procedures at all times.
• Willingness to assist other areas in the RCM department when needed.

JOB REQUIREMENTS

:

• Knowledge of medical billing/collection practices required.
• Excellent billing/collections software expertise, preferably with eClinicalWorks.
• Works well in fast-paced, high volume environments with firm deadlines.
• Results oriented.
• Possesses the ability to multi-task.
• Able to work both independently and as part of a team.
• Strong analytical skills required.
• Capable of making good independent decisions.

QUALIFICATIONS/ REQUIREMENTS

• High school diploma or general equivalency diploma (GED

SAFETY HAZARD OF THE JOB

Minimal Hazards