RCM Administrator

Pediatrica Health Group • Miami, FL

5d

About The Position

The RCM Administrator is a key position in the revenue cycle, responsible for managing the claims process. This includes accurate and timely claim creation, follow-up, and correspondence with providers and insurance companies. The role involves assisting in process improvements, ensuring payments for services are recorded, reconciled, and posted accurately.

Requirements

• Knowledge of medical billing/collection practices required.
• Excellent billing/collections software expertise, preferably with eClinicalWorks.
• Works well in fast-paced, high volume environments with firm deadlines.
• Results oriented.
• Possesses the ability to multi-task.
• Able to work both independently and as part of a team.
• Strong analytical skills required.
• Capable of making good independent decisions.

Responsibilities

• Prepares and submits clean claims to third party payers either electronically or on paper.
• Properly attends to all clearinghouse reports to clear rejections accurately.
• Ensures all eligibility rejections are properly researched and corrected.
• Attends to all requirements for secondary billing protocols.
• Submits resubmissions, evaluating root cause and escalating any trends.
• Communicates effectively with each practice regarding insurance issues.
• Alerts practice staff of open balances by properly documenting in eClinicalWorks.
• Identifies and resolves all billing problems, keeping management informed.
• Uses the alert system in eClinicalWorks to communicate any coding errors.
• Maintains the strictest confidentiality, adhering to all HIPAA regulations.
• Follows collection protocols for assigned accounts (follow up metrics, etc.).
• Maintains worklist ensuring each patient account has been reviewed timely.
• Monitors payments, accessing payor portals regularly for claim status.
• Follows third party rules regarding balance billing.
• Identifies denials, determines root cause, performs appeals.
• Escalates trendy denials to management for further research.
• Provides information to management regarding uncollectable account balances.
• Adheres to KPI metrics for Collection percentages, AR aging, Denial Management, etc.
• Reviews ERA’s and EOB’s as necessary, reporting posting errors to management.
• Actively participates in department staff meetings.
• Keeps abreast of changes in payor regulations and updates.
• Follows departmental Policy and Procedures at all times.
• Willingness to assist other areas in the RCM department when needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED