RCM Billing Specialist

Allergy Partners•Asheville, NC

About The Position

The RCM Billing Specialist is responsible for scrubbing claims for billing accuracy. The Scrubbing department retrieves, approves, batches, and scrubs claims to help prevent errors that could cause claims to reject or deny. The role works with EMR documentation, coding and billing details, claim exceptions, and front-end rejections, and communicates with relevant personnel to resolve questions and concerns. The position also includes monitoring for unretrieved charges, identifying trends and potential needs for additional scrub rules, maintaining patient confidentiality, complying with HIPAA and practice policies, keeping current with healthcare industry changes, completing assigned training, and participating in meetings and other projects as requested. This position has no supervisory duties.

Requirements

High school diploma or equivalent.
At least 18 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 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 operate office equipment, including a keyboard, photocopier, telephone, and calculator.
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.
Review diagnosis coding for appropriateness to the visit and carrier guidelines.
Verify charges, diagnosis pointers, modifiers, and NDCs when necessary, and check for duplicate charges.
Ensure the correct provider, site, insurance, filing type, and referrals or authorizations are selected.
Work exceptions caught by system scrubbing.
Work front-end rejections.
Communicate questions or concerns to appropriate personnel, including hub personnel, providers, the coding team, and others within the CBO.
Approve and batch claims.
Periodically check for unretrieved charges.
Communicate observed trends and identify the need for additional scrub rules based on trends.
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 and practice compliance 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 within designated timeframes.
Comply with Allergy Partners and hub or department policies and report policy violations through designated 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.