Senior RCM Specialist

American Vision Partners•Phoenix, AZ

7d•Onsite

About The Position

The Senior RCM Specialist is responsible for the revenue cycle process, including billing, collections, and regulatory compliance. The position supports maximizing revenue and minimizing losses within the Revenue Cycle Management department. It is based exclusively at the Phoenix Corporate Office in the Biltmore area and requires daily onsite attendance; it is not remote or hybrid.

Requirements

Seven years of medical billing experience.
Active knowledge of CMS guidelines, contracted insurance guidelines, and coding policies.
Computer literacy.
Strong organization and attention to detail.
Ability to read and understand oral and written instructions.
Excellent math skills.
Ability to establish and maintain effective working relationships with team members, clinic staff, payers, and patients.
Professional customer service skills.
Self-discipline and dedication to the work.
Maintain strict confidentiality and adhere to HIPAA guidelines and regulations.
Prior experience working the full revenue cycle in a healthcare setting.

Nice To Haves

Ophthalmology background.

Responsibilities

Follow up with patients and payers to ensure outstanding balances are paid accurately.
Make and receive calls with patients to discuss their accounts in detail.
Contact insurance plans to determine eligibility and obtain coverage and benefit information.
Contact insurance plans to obtain prior authorization for services.
Review outstanding insurance and patient credit balances and determine the appropriate party for refunds.
Accurately post payments, adjustments, and refunds.
Review and gather documentation for payer-requested Risk Adjustment Audits and coordinate onsite chart pulls as appropriate.
Review and appeal unpaid and denied claims, including analysis of coding.
Analyze daily financial exceptions from charge capture audit reports to identify leakage, and work with Information Technology and clinical service lines to resolve charge capture issues and improve compliant charge capture.
Manage timely and accurate processing and submission of provider enrollment applications with payers.
Scan incoming mail and distribute it according to department policy.
Meet or exceed productivity standards for daily assignments and accurate production.
Deposit checks and other payments, confirming that required documents are authorized, in proper form, and within authorized limits.
Develop and maintain in-depth knowledge of banking transactions, including EFT, ERA, paper, checks, and document handling and management.
Perform other assigned duties.