RCM AR Specialist

Veradigm; Raleigh (NC); Hybrid; USD 52,000 - 64,000; Full time

Job summary

Veradigm Inc. in Raleigh, NC is seeking an AR Specialist to maximize collections by recovering accounts receivable and managing insurance claims. You will research denials, prepare appeals, and interact with carriers to resolve issues.

The role supports RCMS operations and client services, with a hybrid work arrangement requiring two days in-office per week. Prior AR and payer portal experience is preferred.

Qualifications

• 1+ year relevant work experience in a medical accounts receivable role.
• Experience with payer portals and claims processing is preferred.
• Familiarity with CPT/ICD-10 coding and modifiers is a plus.

Responsibilities

• Responsible for recovery and management of AR to maximize collections.
• Research and follow-up on medical insurance claims and prepare appeals.
• Interact with insurance carriers and resolve denials and rejections.
• Monitor aged claims, perform reconciliations, and provide KPI results.
• Support operations and client services for RCMS with accuracy and compliance.

Skills

Customer service

Communication

MS Office

Payer websites

Tools

Allscripts PM

MS Access

PowerPoint

Crystal Reports

NextGen

Epic

Job description

JOB SUMMARYResponsible for the overall recovery and management of accounts receivable as it relates to maximizing accounts receivable collections for RCMS clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of appeals and responses to efficiently interact with insurance carriers and resolve the claim. Supports the RCMS BU's overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and achieving KPI results.No budget responsibilities, but must meet established RCM KPI's.This is a hybrid position, 2 days a week in officeESSENTIAL FUNCTIONS/MAJOR JOB RESPONSIBILITIESStrong customer service skills for client satisfaction and client AR health answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for informationTimely management of unpaid claims as assigned, through the use of the client’s office management/administrator;aging reports; correspondence; Clearinghouse and PM rejections; SharePoint reference/maintenanceEffectively handle complex payer denials; responsible to ensure that secondary claims are processed and paid. Monitoring and reconciliation of claims to include:Held vouchersUnbilled vouchersDenial trendsPatient balance reportCredits and refundsManage and track information requests to client.Answer and resolve all incoming calls and requests in a timely manner.Complies with and enforces policies and proceduresAchieves goals set forth by RCM management regarding error-free work, transactions, processes, productivity and compliance requirements. Specific goals include 1,400 accounts worked per monthMay act as partner for new hires to assist them in learningOther duties as assignedJOB REQUIREMENTSRequired1+ year relevant work experiencePrior experience on Allscripts PM (preferred)Knowledge, Skills and AbilitiesExtensive knowledge with email, search engines, InternetA bility to effectively use payer website and Laserfiche; basic competence in use of Microsoft productsPreferred experience with MS Access and PowerPoint, Crystal reportsExperience with various billing systems, such as NextGen, Pro, Allscripts, Epic and othersKnowledge of CPT, ICD10 and modifiers.Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General SurgeryFamiliar with HMO and IPAs, Medicare Fee for Service Plans and Commercial PayersWorking ArrangementsStandard work week or as defined by assignment requirementsPrimarily works in standard office environment or remotelyMay require after-hours, on-call support and/or holidaysOn-call and after hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needsCompensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.Enhancing Lives and Building CareersVeradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?Take a look at our Culture , Benefits , Early Talent Program , and Additional Openings .Visa Sponsorship is not offered for this position.At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.From a \"VEVRAA Federal Contractor\" We request Priority Referral of Protected VeteransThis is an official Veradigm Job posting. To avoid identity theft, please only consider applying to jobs posted on our official corporate site.Thank you for reviewing this Veradigm opportunity. Does this look like a great match for your skill set? If so, scroll on down and tell us more about yourself!