RCM AR Specialist

Veradigm•Raleigh, NC

4d•Hybrid

About The Position

The RCM AR Specialist is responsible for recovering and managing accounts receivable to maximize collections for RCMS clients. The role researches and follows up on medical insurance claims and prepares appeals and responses to resolve claims with insurance carriers. It supports RCMS Operations and Client Services by driving the accounts receivable process and meeting established RCM KPIs. This role has no budget responsibilities. The position is hybrid, with two days per week in the office. Work is primarily in a standard office environment or remotely. The schedule is a standard work week or as defined by assignment requirements; after-hours, on-call, and holiday support may be required, particularly during month-, quarter-, and year-end peak periods, when PTO is limited to meet business needs.

Requirements

At least 1 year of relevant work experience.
Strong customer service skills.
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 IPA plans, Medicare Fee for Service plans, and commercial payers.
Ability to meet established RCM KPIs and productivity and compliance goals.

Nice To Haves

Prior experience with Allscripts PM.
Experience with MS Access, PowerPoint, and 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 clients, patients, and insurance carriers, including answering calls, returning and following up on interactions, and responding promptly to requests for information.
Manage assigned unpaid claims in a timely manner using client office management or administrator systems, aging reports, correspondence, clearinghouse and practice-management rejections, and SharePoint references.
Handle complex payer denials and ensure secondary claims are processed and paid.
Monitor and reconcile claims, including 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 accuracy, transactions, processes, productivity, and compliance, including a target of 1,400 accounts worked per month.
May partner with new hires to help them learn.
Perform other duties as assigned.