Lead, RCM Specialist

AdaptHealth, LLC • Phoenixville, PA

73d

About The Position

The Lead, Revenue Cycle Management Specialist is the subject matter expert for insurance payer accounts receivables and will be responsible for assisting the management team with leadership oversight of the RCM domestic and global teams. This individual will provide work assignments, feedback, training, and guidance to ensure RCM staff is following department protocol with RCM processes. The Lead for RCM will handle escalated phone calls from patients or insurance companies that cannot be effectively resolved by offshore staff. This individual will work closely with the supervisor and management to identify payor trends and develop RCM process improvements.

Requirements

• High School Diploma required; Associated degree preferred.
• Three (3) years related work experience in health care administrative, financial, insurance, customer services, claims, billing, call center, or management regardless of industry required.
• Two (2) exact job experience in HME, Diabetic, home medical supplies, Pharmacy, HH environment is preferred.
• Exact job experience is considered any of the above tasks in a Medicare-certified HME, IV, or HH environment that routinely bills insurance.

Responsibilities

• Mentors guide and provide oversight assistance to the team.
• Applying subject expertise in evaluating business operations and processes.
• Identifying areas where technical solutions would improve business performance.
• Consulting across teams, providing mentorship, and contributing specialized knowledge.
• Demonstrated various techniques and documentation to streamline the production process.
• Identify team members' strengths and opportunities and report findings to supervisors.
• Respond to internal inquiries for coaching assistance via the subject matter expert queue, office communicator, and email.
• Assume responsibility for resolving team member escalations by working with multiple business partners while consistent communication is present with the member.
• Coach others on how to navigate through systems to find information needed for calls.
• Assist with training new employees and assist other CSRs with problems they encountered while interacting with members over the phone.
• Performed ad hoc deep-dive analyses for specific business problems.
• Training and development of team members to ensure AdaptHealth policy and protocol are being followed.
• Take escalated phone calls that cannot be effectively resolved by team members.
• Communicate with other departments, front end staff regarding billing issues and trends to work toward an account resolution and decrease insurance denial percentages within AdaptHealth.
• Handle all insurance payer disputes that are filtered into the department.
• Identify trends and root causes related to inaccurate insurance billing, and report to the manager while resolving account errors.
• Assist in conducting team meetings to educate on insurance guidelines, claim denials, and re-training efforts on accounts incorrectly worked.
• Develops and enhances the process and payer-specific work job aids and standard operating procedures.
• Investigate escalated insurance billing inquiries and inaccuracies and take appropriate action to resolve the account.
• Provides quality payer feedback to other AdaptHealth leadership.
• Develop and maintain a working knowledge of current AdaptHealth products and services offered by the company.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliance with AdaptHealth’s Compliance Program.
• Perform other related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees