RCM Specialist- Home Health and Hospice

Job Summary: 

The RCM Specialist for Home Health & Hospice plays a crucial role in ensuring the efficient and accurate processing of claims and patient accounts, contributing to the organization's financial health. They possess a comprehensive understanding of revenue cycle processes and demonstrate expertise in resolving complex claims and patient billing issues. 

Essential Duties and Responsibilities: 

• Lead and optimize the full revenue cycle process from billing the claim to final payment collection. 
• Collaborate with the RCM team to maintain a clean and compliant revenue cycle. 
• Generate claims accurately from EMR system to clearinghouse and monitor the claim following HRP standard protocol. 
• Resubmit claims corrected as needed and communicate issues that need to be resolved. 
• Communicate unbilled and billed claim holds to Team Leader or RCM Manager. 
• Analyze and resolve complex claims denials and appeals. 
• Investigate and address patient billing discrepancies and disputes. 
• Identify and implement strategies to improve revenue cycle performance as needed. 
• Collaborate with cross-functional teams to implement and manage assigned RCM accounts. 
• Participate in revenue cycle audits and compliance reviews (quality review checks). 
• Develop and maintain accurate and up-to-date documentation of all claims and patient accounts. 
• Provide training and support to other RCM team members. 

Key Performance Indicators (KPIs): 

• Clean claim rate >95% 
• Aged AR < 20% of total AR 
• Meets productivity expectation of 45 non-Medicare claims per day or 75 Medicare 
• Net collection rate of >95% 
• Meets and passes 100% of quality review checks completed by RCM Manager 

Qualifications: 

• 3–5 years of experience in revenue cycle management in the home health and hospice realm
• Proficient in Microsoft Office Suite 365 
• Proficient in home health and hospice electronic health records (EHR) systems 
• Strong understanding of insurance billing and coding procedures 
• Excellent communication, problem-solving, and analytical skills 
• Ability to work independently and as part of a team 
• Proven track record of success in resolving complex claims and patient billing issues 

Benefits: 

• Competitive salary and comprehensive benefits package, including health insurance, dental insurance, vision insurance, paid time off, and 401k savings plan 
• Opportunity to work in a dynamic and growing healthcare organization 
• Professional development and training opportunities 
• Contribution to the organization's financial success and patient satisfaction