RCM Specialist

- Execute all assigned revenue cycle management (RCM) tasks following best practices and internal standard operating procedures. - Verify insurance coverage and benefits for scheduled patients using payer portals or phone interactions. - Accurately record and update insurance data in the practice management system. - Confirm eligibility, plan limitations, and coordinate benefits to ensure timely and accurate claim submissions. - Prepare and send pre-determinations and pre-authorizations requested by patients or practices, including all necessary clinical attachments, and follow up on their status to avoid treatment delays. - Submit claims in compliance with payer-specific guidelines and deadlines, whether electronically, on paper, or via portal. - Assess rejected claims, determine the causes, and resubmit corrected claims as necessary. - Provide timely and professional responses to patient and office inquiries regarding billing, insurance coverage, and outstanding balances. - Assist in generating and distributing patient statements, and follow up on unresolved balances as directed. - Document all results from insurance verifications, pre-authorizations, claim submissions, and patient interactions thoroughly and clearly. - Escalate any issues related to claim delays, system errors, or patient concerns to the appropriate RCM team members or supervisors. - Ensure compliance with HIPAA, payer guidelines, and internal policies. - Engage in team meetings and training sessions to keep updated on processes, tools, and payer changes. - Support other RCM functions as required to facilitate a seamless revenue cycle process. - Aid RCM management in self-identifying contributing factors to site-specific RCM KPIs and highlight areas needing attention or improvement.