Revenue Cycle Management (RCM) Specialist Team Leader

Job Title: Revenue Cycle Management (RCM) Specialist – Team Leader

Reports To: RCM Manager

Summary:

The RCM Specialist serves as a seasoned expert in revenue cycle management, playing a pivotal role in optimizing the organization's financial performance. They possess in-depth knowledge of revenue cycle processes, insurance billing regulations, and coding guidelines. Their expertise is instrumental in resolving complex claims issues, ensuring accurate reimbursement, and maximizing revenue.

Essential Duties and Responsibilities:

• Serves as the primary point of contract for assigned clients, managing their RCM business and addressing concerns.
• Conducts regular focus meetings with clients (following HRP designated process) to review performance, discuss challenges, and identify opportunities for improvement.
• Lead and mentor RCM team members, providing guidance for day-to-day questions and training on revenue cycle processes and procedures as needed.
• Helps resolve complex claim issues and member escalations.
• Analyze and resolve highly complex claims denials and appeals, advocating for the organization's reimbursement claims.
• Conduct in-depth investigations into patient billing discrepancies and disputes, ensuring timely resolution and client satisfaction.
• Develop and implement strategies to improve revenue cycle efficiency and reduce claim denials.
• Assists with revenue cycle audits and compliance reviews, ensuring adherence to regulatory standards.
• Maintain accurate and up-to-date documentation of all claims and patient accounts in clearinghouse, EMR, and Velocity.
• Monitors productivity expectations for the team based on Medicare and Non-Medicare claims worked expectations.
• Identifies opportunities for process optimization with the RCM department.
• Contribute to the development and implementation of revenue cycle management policies and procedures as needed.
• Serves as a subject matter expert for RCM claims management for assigned accounts.
• Collaborates with internal and external stakeholder to improve overall claim and collections AR performance.
• Stay abreast of changes in insurance billing regulations and coding guidelines, ensuring the organization's compliance.

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%
• Client satisfaction score.
• Meets 100% of quality review checks completed by RCM Manager

Qualifications:

• Bachelor's degree in healthcare administration, business administration, or a related field preferred
• 5+ years of experience in revenue cycle management or a related field, with demonstrated expertise in resolving complex claims issues
• Proficient in Microsoft Office Suite.
• Proficient in home health and hospice electronic health records (EHR) systems, and revenue cycle management software
• Proficient in Part B billing.
• In-depth understanding of insurance billing and coding procedures, including ICD-10-CM and CPT codes
• Exceptional communication, problem-solving, and analytical skills
• Proven ability to work independently and as part of a team
• Demonstrated leadership skills and the ability to mentor and train others

Benefits:

• Competitive salary and comprehensive benefits package, including health insurance, dental insurance, vision insurance, front loaded paid time off, and retirement savings plan
• Opportunity to work in a dynamic and growing healthcare organization, making a significant impact on its financial success
• Professional development and training opportunities, including conferences, webinars, and certifications
• Recognition and rewards for outstanding performance and contributions to the organization's goals