Revenue Cycle Management Specialist (AR Focus)

Summary/Objective: 

The RCM Specialist is responsible for all billing duties listed below. The position requires coordination with client contact for the daily and monthly revenue cycle management process.

Essential Functions:

Core duties and responsibilities include the following. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

Claims Processing

• Progress notes and account review
• Patient demographic and insurance updates
• Billing related alert creation and deletion
• Claims processing (both paper and electronic)
• Clearinghouse review and management of rejected claims
• Management and follow up of client returned claims

Payment Processing

• Daily balancing
• Payment posting (both manual and electronic)
• Collection management

AR Follow-Up

• Insurance website navigation and maintenance of log in access
• E-status review for provider participation status
• Patient statements processing
• Refunds, small balance, and bad debt adjustments

Denials

• Claim denial management
• NGS Fiscal Intermediary Shared System resubmission of denied Medicare Part A claims

Internal – Cenevia

• Submission and follow up of ECW support tickets and CCNV IT support tickets

Client Communication

• Provides information to client/team lead on account issues to be discussed with client
• Responds to team and client timely and thoroughly

Core Values

• Professional communications to clients and company employees 
• Patient phone calls and interpretive management services
• Continued education and internal training 
• Special projects as assigned 

Leadership

• Accounts Receivable management reports review and follow up
• Responsibility to monitor common claim processing and denials and department goals and KPI’s
• Reassigns duties in absence in coordination with client/team lead supervisor

QUALIFICATIONS:

• Applicant must have two years of experience in insurance reimbursement, account collections, coding and medical terminology. 
• Significant experience performing and managing billing services for a Federally Qualified Health Center (FQHC).
• Advanced proficiency in eClinicalWorks (eCW).
• Candidate should be proficient in using Microsoft Excel and Word. 
• Must have excellent customer service and communication skills. 
• High school diploma or equivalent required. 

COMPETENCIES:

To perform the job successfully, an individual should demonstrate the following competencies:

• Accountability and Results - Assuming responsibility for successfully completing assignments or tasks; self-imposing excellence standards rather than waiting for others to impose or enforce them.
• Client Focus - Anticipating, understanding, and fulfilling customer needs and expectations by providing excellent direct and indirect service.
• Problem Solving -- Using problem analysis skills to identify and define issues for resolution and choosing optimum courses of action.
• Productivity - Ensuring efficiency requirements are met even in the face of time or resource restrictions.
• Quality Focus - Assuring quality standards are met within appropriate specifications by accurately checking process and tasks over time.
• Teamwork - Working effectively as part of a team through the practices of subordination, support, and cooperation.

 PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand and walk.

The employee must occasionally lift and/or move up to 10 pounds.

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

The noise level in the work environment is usually moderate.

Cenevia is an equal opportunity employer.

At Cenevia, we believe diversity brings strength and adaptability by drawing on a broad range of talents, experiences and perspectives, and affords an inclusive workplace and culture where all people, regardless of gender, race, ethnicity, sexual orientation, or background, feel a sense of belonging.