Remote RCM Specialist

- Execute all assigned revenue cycle management (RCM) activities following best practices and internal standard operating procedures. - Conduct AR follow-ups to resolve unpaid or underpaid claims, denials, and aged balances through necessary actions such as appeals, corrections, and resubmissions. - Perform account audits to ensure accurate claim submissions, payment applications, adjustments, and resolution of outstanding balances. - Review and manage credit balances, processing refunds to both insurance and patients in compliance with relevant regulations and internal policies. - Accurately post all payments—insurance and patient—timely, including zero-dollar payments and remittance reconciliations (both manual and electronic). - Apply adjustments and write-offs in accordance with payer contracts and internal guidelines. - Regularly work on AR aging reports to decrease days in AR and minimize the percentage of AR over 90 days. - Maintain meticulous documentation of account activities, payer interactions, and refund processes. - Collaborate with internal teams (billing, front office) to ensure accurate claims submission and swift resolution of issues. - Ensure compliance with HIPAA, applicable payer guidelines, and internal policies. - Engage actively in team discussions regarding performance metrics, workflow changes, and potential process enhancements. - Support management in analyzing site-specific RCM KPIs, noting areas needing attention or potential improvements. - Monitor the net collection rate, tracking performance against established targets and advocating for improvement opportunities. - Assess and report on the average days in AR, ensuring the effectiveness of collection, payment application, and timely claim resolution. - Analyze trends in rejections, disputes, payment delays, and denials while investigating root causes to prevent future occurrences. - Maintain professionalism and respect in all interactions with stakeholders, patients, payers, and third parties.