RCM Analyst - Ortho Clinic

Carilion Medical Center•Roanoke, VA

7d•Onsite

About The Position

Identifies and analyzes problem accounts, determines solutions and implements corrections to result in accurate processing/payment of claims. Investigates billing and insurance problems or issues as it relates to coding, services provided and associated charges with the total patient account. May coordinate computer system functionality in order to obtain reimbursement while working with a variety of complex billing issues. Some positions may require a strong working knowledge of multiple payers knowing payer specific policies and procedures in order to serve as subject matter expert. Makes important decisions and determination of proper adjudication by the payers for claims. Works in a fast-paced, office environment with high productivity and accuracy standards that requires focus and concentration on tedious details and research. Investigate and identify errors in billing, coding or procedures relating to patient accounts. Conducts analysis of complex accounts. Determines actions and completes action steps to resolve accounts. Serving as a subject matter expert and provides guidance to RCM Specialists. Communicates effectively with patients, staff and has a excellent understanding of various procedures and process associated with billing and reimbursement. Collaboration with team lead/training team in recommending solutions to management related to insurance issues, departmental procedures, and operations. Facilitates special assignments based on payer requirements, specialized functions and processes. Manages denial, aged, no response, at risk account work queues. Possesses the knowledge for working with multiple payers with proven success. Reports any erroneous processing trends by payer to team lead/management.

Requirements

High School graduate, with extended college course work preferred in Business or Accounting.
Minimum of five (5) years medical billing required, with proven communication, analytical and problem-solving skills.
Proficiency in EPIC Fundamentals required.
Must be able to meet high productivity and accuracy standards.
High focus and concentration needed for computer, analytical, organizational and time management required.
Visual perception and high hand/eye coordination necessary.
Requires excellent hearing, clear/concise speech, excellent finger dexterity to operate computer terminal/keyboarding as well as use of a calculator.
Must be proficient with word processing, computer/PC skills.
Excellent documentation and follow-up skills required.

Nice To Haves

EPIC Administrator preferred

Responsibilities

Identifies and analyzes problem accounts, determines solutions and implements corrections to result in accurate processing/payment of claims.
Investigates billing and insurance problems or issues as it relates to coding, services provided and associated charges with the total patient account.
May coordinate computer system functionality in order to obtain reimbursement while working with a variety of complex billing issues.
Makes important decisions and determination of proper adjudication by the payers for claims.
Investigate and identify errors in billing, coding or procedures relating to patient accounts.
Conducts analysis of complex accounts.
Determines actions and completes action steps to resolve accounts.
Serving as a subject matter expert and provides guidance to RCM Specialists.
Communicates effectively with patients, staff and has a excellent understanding of various procedures and process associated with billing and reimbursement.
Collaboration with team lead/training team in recommending solutions to management related to insurance issues, departmental procedures, and operations.
Facilitates special assignments based on payer requirements, specialized functions and processes.
Manages denial, aged, no response, at risk account work queues.
Reports any erroneous processing trends by payer to team lead/management.