RCM Billing Specialist

ALLERGY PARTNERS•Asheville, NC

About The Position

The RCM Billing Specialist is responsible for reviewing and scrubbing claims for billing accuracy to help prevent claim rejections and denials. The role retrieves, reviews, approves, batches, and scrubs claims, checking documentation and billing details for accuracy and compliance with carrier guidelines. It also involves resolving system exceptions and front-end rejections, communicating questions and observed trends to relevant colleagues, and identifying potential needs for additional claim-scrubbing rules. The position requires maintaining confidentiality and following HIPAA, compliance, and practice policies. The specialist keeps current with healthcare industry changes through education, maintains working knowledge of relevant practice management and computer software, completes assigned training, and participates in meetings and other projects as assigned. This position has no supervisory duties.

Requirements

High school diploma or equivalent.
At least eighteen months of experience in a medical office reimbursement department.
Comfort using email and interacting with Internet applications.
Working knowledge of MS Excel and MS Word, and an understanding of practice management software.
Basic understanding of Explanation of Benefits forms, claim forms, and the insurance billing process.
Strong written and verbal communication skills.
Ability to meet the stated physical demands, including prolonged sitting, occasional lifting of approximately 20–30 pounds, some bending, stooping, and stretching, and operating office equipment with adequate eye-hand coordination and manual dexterity.
Normal range of hearing and vision correctable to the normal range.

Responsibilities

Retrieve claims from the Electronic Medical Records (EMR).
Review EMR documentation where appropriate.
Check diagnosis coding for appropriateness to the visit and compliance with carrier guidelines.
Verify charges, diagnosis pointers, modifiers, and NDCs when necessary, and check for duplicate claims or charges.
Ensure the correct provider, site, insurance, filing type, and referrals or authorizations are selected.
Work system-scrubbing exceptions and front-end rejections.
Communicate questions or concerns to appropriate personnel, including hub personnel, providers, the coding team, and others in the CBO.
Approve and batch claims.
Periodically check for unretrieved charges.
Communicate observed trends and recognize when additional scrub rules may be needed.
Work independently and as part of a team, shifting between projects while maintaining productivity and efficiency.
Attend Medicare and other continuing education courses as requested and pursue education to remain current with healthcare industry changes.
Maintain patient confidentiality and comply with HIPAA, compliance, and practice guidelines.
Maintain detailed knowledge of practice management and other computer software related to job functions.
Attend meetings as requested, including regular staff meetings.
Complete assigned AP training, such as CPR, OSHA, HIPAA, Compliance, and Information Security training, within designated timeframes.
Comply with Allergy Partners and hub or department policies, and report policy violations through the specified channels.
Model the AP Code of Conduct and demonstrate commitment to the AP Compliance Program, standards, and policies.
Complete other projects and duties as assigned.