RCM Specialist

Agape Network Inc • Goulds, FL

7h

About The Position

The Revenue Cycle Management Specialist will coordinate the Authorizations and Referrals process between Agape and the Insurance plan. This role is responsible for Pre-Billing Reviews of Third-party Billing Queues to locate claims that need to be edited/corrected to ensure claims are billed accurately.

Requirements

• High school diploma or equivalent
• Familiar with Primary Care billing
• Billing reconciliation
• CPT Codes

Responsibilities

• Analyzes the patient record to determine legitimacy of admission, and treatment.
• Reviews all Insurance coverage information to request prior authorization in the monthly bases from the Insurance within the established department turnaround time. Routinely communicates with clinical staff and supervisors on all authorization inquiries to reduce the occurrence of non-authorized services.
• Perform ongoing audits on Billing Queues to establish clean claim billing/adjudication
• Responsible for timely re-submission and accuracy for billing claims.
• Reviews claim elements as Credentialing, Authorizations, Coding, and making sure we are billing the correct Insurance. Research balances and takes necessary collection actions=
• Collaborate and work cross functionally with departments to ensure pre- billing is completed. Identify, analyze, and research the root cause of the denials and underpayments.
• Staff is responsible to maintain updated insurance information on all patients
• Collect co-payments, deductibles, and other applicable balances from patients in person or by phone
• Participates in the continuous quality improvement process.
• Perform all other duties as assigned or required
• Assist the department in cross training existing staff, and new hires.

Benefits

• Retirement: 403b plan
• Balance: Competitive vacation and sick plan, 12 paid Holidays.
• Development: Leadership development, personal and professional growth.
• Culture: Loved and faith-based mission, respect to diversity; going through expansion and growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees