Revenue Cycle Management (RCM) Specialist

ActivStyle•Minneapolis, MN

16h•Onsite

About The Position

ActivStyle is hiring a Revenue Cycle Management (RCM) Specialist for its Minneapolis office. The role maintains a timely revenue cycle for the goods and services ActivStyle provides, including incontinence supplies, urological items, and other personal care essentials. The specialist helps ensure accurate billing, payment, authorization, claims processing, and revenue recognition while maintaining patient confidentiality in accordance with HIPAA and complying with ActivStyle’s Compliance Program. The role also includes completing assigned compliance training and educational programs.

Requirements

High school diploma or equivalent.
At least one year of work-related experience in healthcare administration, finance, insurance customer service, claims, billing, call center, or management, regardless of industry.
Decision-making ability.
Analytical and problem-solving skills with attention to detail.
Strong verbal and written communication skills.
Excellent customer service skills.
Proficient computer skills and knowledge of Microsoft Office.
Ability to prioritize and manage multiple tasks.
Ability to learn new technologies and technical aptitude to understand data flow through systems and interactions between systems.
Ability to maintain patient confidentiality and comply with HIPAA requirements.

Nice To Haves

Exact job experience in any of the listed work areas within a Medicare-certified HME, diabetic supplies, pharmacy, or home medical supplies environment that routinely bills insurance.

Responsibilities

Ensure accurate payment for goods and services according to contracted rates and payer fee schedules.
Collect on accounts by sending claims, invoices, and statements by phone, email, fax, mail, or websites.
Reconcile accounts receivable and ensure payments are accounted for and properly posted.
Investigate and resolve customer inquiries regarding charges, payment discrepancies, non-payments, delayed payments, and account irregularities.
Communicate with customers about insurance, payments, and invoices; make and receive calls with internal and external clients to resolve issues.
Resolve credit balances and issue insurance or patient refunds as needed.
Identify billing compliance issues, payment trends, and root causes of inaccurate payments, escalating them as appropriate.
Collaborate with internal and external customers to provide authorization status updates and coordinate appeals on denied authorizations.
Reconcile approved authorizations and pending charges to resolve pending revenue.
Confirm orders will bill correctly to insurance and have valid proof of delivery.
Submit or print eligible claims daily and resolve claim rejections promptly within payer timely-filing requirements.
Identify claim rejection trends and escalate them to support education or process improvements.
Maintain daily, weekly, and monthly system or database functions and review payer requirements and notifications for fee schedule or other changes, alerting the supervisor as needed.
Analyze billing edits for compliance with payer requirements; reconcile received documentation and pending charges; audit accounts and ensure services are billed to the correct payer.
Ensure proper revenue recognition for billed charges and services.
Identify and report trends and root causes of inaccurate private-pay billing, investigate escalated billing inquiries, and resolve account errors and returned payments.
Resolve patient account inaccuracies and demographic issues.
Update data elements that support revenue generation and reduce denial rates; collaborate with RCM leadership to improve productivity, follow frameworks, and maintain documentation.
Independently complete assigned tasks and small projects.
Educate patients, staff, and providers about authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends.
Maintain knowledge of payer coverage, insurance policies, payer guidelines, and payer contracts to support accurate billing and timely payment.
Accurately enter payer, authorization, coverage limitation, and requalification status data into databases.
Develop and maintain working knowledge of the company’s current HME products and services.
Maintain patient confidentiality in accordance with HIPAA, complete assigned compliance training and educational programs, comply with ActivStyle’s Compliance Program, and perform other related duties as assigned.