RCM Specialist

Private Advertiser; Quezon City; On-site; PHP 420,000 - 640,000; Full time

Job summary

Private Advertiser is seeking an RCM Specialist for Home Health & Hospice in the Philippines. The role focuses on accurate processing of claims and patient accounts, leveraging extensive knowledge of revenue cycle processes to resolve complex billing issues.

The position requires 3–5 years in RCM for home health/hospice, proficiency with MS Office 365 and EHR systems, and a proven record of improving revenue cycle performance.

Qualifications

• College graduate in a related field or equivalent experience.
• 3–5 years in revenue cycle management for home health/hospice.
• Proficient with MS Office 365 and EHR systems used in home health.
• Strong insurance billing and coding knowledge.
• Excellent communication, problem-solving and analytical skills.
• Capable of working independently or in a team.
• Proven track record resolving complex claims and billing issues.
• Reliable internet connection.

Responsibilities

• Lead full revenue cycle from billing to final payment collection.
• Collaborate to maintain a clean, compliant revenue cycle.
• Generate claims from EMR to clearinghouse and monitor following protocol.
• Resubmit corrected claims and communicate issues for resolution.
• Communicate unbilled/billed claim holds to leadership.
• Analyze and resolve complex denials and appeals.
• Investigate patient billing discrepancies and disputes.
• Identify strategies to improve revenue cycle performance.
• Collaborate with cross-functional teams on RCM accounts.
• Participate in audits and compliance reviews.
• Maintain documentation of all claims and patient accounts.
• Provide training and support to RCM team members.

Skills

Communication

Problem-solving

Analytical skills

Teamwork / collaboration

Independent work

Education

College degree in related field

Tools

Microsoft Office 365

Home health EHR systems

Job description

JOB OVERVIEW

The RCM Specialist for Home Health & Hospice plays a crucial role in ensuring the efficient and accurate processing of claims and patient accounts, contributing to the organization's financial health. They possess a comprehensive understanding of revenue cycle processes and demonstrate expertise in resolving complex claims and patient billing issues.

KEY RESPONSIBILITIES

• Lead and optimize the full revenue cycle process from billing the claim to final payment collection.
• Collaborate with the RCM team to maintain a clean and compliant revenue cycle.
• Generate claims accurately from EMR system to clearinghouse and monitor the claim following HRP standard protocol.
• Resubmit claims corrected as needed and communicate issues that need to be resolved.
• Communicate unbilled and billed claim holds to Team Leader or RCM Manager.
• Analyze and resolve complex claims denials and appeals.
• Investigate and address patient billing discrepancies and disputes.
• Identify and implement strategies to improve revenue cycle performance as needed.
• Collaborate with cross-functional teams to implement and manage assigned RCM accounts.
• Participate in revenue cycle audits and compliance reviews (quality review checks).
• Develop and maintain accurate and up-to-date documentation of all claims and patient accounts.
• Provide training and support to other RCM team members.

QUALIFICATIONS

• College graduate of any related field or equivalent combination of education, training and experience
• 3–5 years of experience in revenue cycle management in the home health and hospice realm
• Proficient in Microsoft Office Suite 365
• Proficient in home health and hospice electronic health records (EHR) systems
• Strong understanding of insurance billing and coding procedures
• Excellent communication, problem-solving, and analytical skills
• Ability to work independently and as part of a team
• Proven track record of success in resolving complex claims and patient billing issues
• Must have a stable and reliable internet connection