RCM AR Specialist

Veradigm•Raleigh, NC

1d•Hybrid

About The Position

The RCM AR Specialist is responsible for recovering and managing accounts receivable to maximize collections for RCMS clients. The role involves researching and following up on medical insurance claims, preparing appeals and responses, and working with insurance carriers to resolve claims. The specialist supports RCMS Operations and Client Services by managing the accounts receivable process and meeting established KPIs. This position has no budget responsibilities. It is hybrid, with two days per week in the office, and is primarily performed in a standard office environment or remotely.

Requirements

At least 1 year of relevant work experience.
Extensive knowledge of email, search engines, and the Internet.
Ability to use payer websites and Laserfiche effectively.
Basic competence with Microsoft products.
Knowledge of CPT, ICD-10, and modifiers.
Familiarity with HMO and IPAs, Medicare Fee for Service Plans, and commercial payers.
Ability to work a standard work week or as defined by assignment requirements; after-hours, on-call, or holiday support may be required.

Nice To Haves

Prior experience with Allscripts PM.
Experience with MS Access and PowerPoint.
Experience with Crystal Reports.
Experience with billing systems such as NextGen, Pro, Allscripts, and Epic.
Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, or General Surgery.

Responsibilities

Provide customer service to support client satisfaction and accounts receivable health by answering client, patient, and carrier calls; promptly returning and following up on interactions; and responding to information requests.
Manage assigned unpaid claims in a timely manner using client office management or administrator systems, aging reports, correspondence, clearinghouse and PM rejections, and SharePoint references.
Handle complex payer denials and ensure secondary claims are processed and paid.
Monitor and reconcile held vouchers, unbilled vouchers, denial trends, patient balance reports, credits, and refunds.
Manage and track information requests to clients.
Answer and resolve incoming calls and requests in a timely manner.
Comply with and enforce policies and procedures.
Meet RCM management goals for error-free work, transactions, processes, productivity, and compliance, including working 1,400 accounts per month.
May partner with new hires to help them learn.
Perform other duties as assigned.