RCM Claims Specialist (Palliative Care)
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About The Position
Under the direction of the Director of Revenue Cycle Management, this position handles incoming mail for palliative care, claims issues via the claims issue log and aging within Insync. The role involves opening, reviewing, and distributing all incoming Palliative Care mail, which includes incoming checks for deposit to ASC and CPC. The individual will review the daily claims issue log to identify, correct, and resubmit claims denials, which may require reviewing patient demographic information and making phone calls to applicable insurance companies for insurance eligibility verification. The position requires responding promptly to any requests for response or follow-up sent by the RCM Insync team within five business days. The individual will provide the RCM Company with all documentation received from payers, including explanations of benefits, payer newsletters, and pre-existing questionnaires, using specified storage and notification methods. Additionally, the role involves pulling updated face sheets from various hospital EMR systems to ensure patient data is up to date for claims correction, reviewing alerts/task messages from the RCM team, and acting as a resource for RCM third-party claims. The individual will coordinate with applicable staff to report on payer or provider contract and system issues, identify and track billing issues with ERAs received, and proactively identify solutions to improve departmental effectiveness. The position also includes assisting the RCM Supervisor by reviewing incoming remits and handling communications regarding standard patient pay statement calls. The individual must attend weekly conference calls with RCM to discuss financial reports or billing-related issues and complete all RCM Services training. Compliance with all applicable laws and regulations related to claims submission is required, and the individual may act as backup for some duties of the CPC RCM Supervisor. Special projects and other duties as assigned by management are also part of the role.
