RCM Administrator

Pediatrica Health Group; Miami (FL); On-site; USD 42,000 - 64,000; Full time

Job summary

Pediatrica Health Group is seeking a Revenue Cycle Management Administrator to manage claims, follow-up, and correspondence with providers and payors in a busy pediatric practice in Florida. The role emphasizes accuracy, HIPAA compliance, and timely posting of payments.

The ideal candidate will have solid medical billing knowledge, experience with eClinicalWorks, and the ability to multi-task in a fast-paced setting while working well within a team and taking initiative on process improvements.

Qualifications

• Knowledge of medical billing/collection practices.
• Experience with claims submission and follow-up.
• Ability to work in a fast-paced, high-volume environment.
• Strong analytical skills and attention to detail.
• Capable of independent decision-making and teamwork.

Responsibilities

• Prepares and submits clean claims to third party payers electronically or on paper.
• Handles clearinghouse reports and resolves eligibility rejections.
• Researches and corrects billing issues and communicates with practices.

Skills

Billing knowledge

eClinicalWorks

Multi-tasking

Analytical skills

Teamwork

Independent decisions

Education

High school diploma or GED

Tools

eClinicalWorks

Payor portals

Job description

POSITION SUMMARY:

Every day is a good day to prepare for a healthy tomorrow. Providing children and their families with equitable access to quality pediatric care to build a foundation for a lifetime of optimal health and wellness is what drives our team to deliver its best every day. It’s our purpose.

Offering focused care from tots to teens, our pediatric primary care providers and teams partner with families to foster good health and strong, thriving communities. Second-to-none medical staff and top-tier administrative professionals keep our practices running smoothly and make each patient experience the best we can offer.

Working in partnership with patients, families, and communities who put their trust in us for their care, we hold ourselves accountable to ensure equitable access to care, advocate to create impactful change, and continually learn and progress to create better outcomes and brighter futures. Together, we’re paving the way for kids to develop into healthy young adults. Rooted in these values , we continue to grow and serve. Are you ready to join us?

The RCM Administrator, a key position in the revenue cycle, manages the claims process, including

accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries.

The incumbent will assist in the clarification and development of process improvements and inquiries,

assure payment for services rendered are recorded, reconciled timely, and posted accurately.

DUTIES RESPONSIBILTIES

BILLING AND CLAIMS:

• Prepares and submits clean claims to third party payers either electronically or on paper.
• Properly attends to all clearinghouse reports to clear rejections accurately Ensures all eligibility
• rejections are properly researched and corrected.
• Attends to all requirements for secondary billing protocols.
• Submits resubmissions, evaluating root cause and escalating any trends. Communicates effectively with each practice regarding insurance issues.
• Alerts practice staff of open balances by properly documenting in eClinicalWorks. Identifies and resolves all billing problems, keeping management informed. Uses the alert system in eClinicalWorks to communicate any coding errors. Maintains the strictest confidentiality, adhering to all HIPAA regulations.

COLLECTIONS:

• Follows collection protocols for assigned accounts (follow up metrics, etc.)
• Maintains worklist ensuring each patient account has been reviewed timely.
• Monitors payments, accessing payor portals regularly for claim status.
• Follows third party rules regarding balance billing.
• Escalates trendy denials to management for further research.
• Provides information to management regarding uncollectable account balances.
• Adheres to KPI
• Reviews ERA’s and EOB’s as necessary, reporting posting errors to management. OTHER:
• Actively participates in department staff meetings.
• Keeps abreast of changes in payor regulations and updates.
• Follows departmental Policy and Procedures at all times.
• Willingness to assist other areas in the RCM department when needed.

JOB REQUIREMENTS :

• Knowledge of medical billing/collection practices required.
• Excellent billing/collections software expertise, preferably with eClinicalWorks.
• Works well in fast-paced, high volume environments with firm deadlines. Results oriented.
• Possesses the ability to multi-task.
• Able to work both independently and as part of a team.
• Strong analytical skills required.
• Capable of making good independent decisions.

QUALIFICATIONS/ REQUIREMENTS

• High school diploma or general equivalency diploma (GED