RCM Specialist

AdaptHealth, LLC; United States; Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical, dental, and vision

401(k) with company match

Employee Stock Purchase Plan

Short and Long-term Disability

HSA/FSA

Job summary

AdaptHealth, LLC is seeking an RCM Specialist to maintain a timely revenue cycle and ensure accurate payment for goods and services according to contracted rates and payer schedules, while protecting patient confidentiality under HIPAA.

You will collect on accounts, follow up with payers, resolve billing inquiries, coordinate authorizations, and reconcile documentation to ensure claims bill correctly to insurance, requiring strong analytical and computer skills.

Qualifications

• 1 year work experience in healthcare administrative, financial, or insurance customer services, claims, billing, call center or management.
• Knowledge of payer guidelines and insurance billing processes.
• Familiarity with Medicare/Medicaid or private payer billing environments.

Responsibilities

• Collect on accounts and follow up with payers via calls, emails, or portals; monitor for non-payments.
• Communicate with patients, providers, and payers regarding charges, eligibility, and documentation.
• Investigate and resolve billing inquiries, including escalated issues and disputes.
• Coordinate authorizations and appeals on denials; ensure documentation and authorizations are up to date.
• Submit daily claims and resolve rejections to meet payer filing deadlines.

Skills

Analytical thinking

Microsoft Office

Prioritization

HIPAA compliance

Education

High School Diploma

Job description

At AdaptHealth we offer full-service home medical equipment and related services that empower patients to live their best lives – beyond the hospital and at home.

With supporting locations across the nation, AdaptHealth is the vital link in the healthcare ecosystem that bridges the gap between patients, providers, and high-quality, compassionate care.

If you’re passionate about making a meaningful and lasting difference in the lives of patients, we invite you to explore a career with AdaptHealth.

Adapt Difference

• Commitment to Our People – Support, Development, and Advancement Opportunities
• Competitive Compensation and Incentives
• Industry-Leading Care & Innovation

Position Summary

The RCM Specialist is responsible for maintaining a timely revenue cycle and ensures accurate payment for goods and services according to contracted rates and/or payor fee schedules. Also responsible for maintaining patient confidentiality and function within the guidelines of HIPAA.

Job Duties:

• Collect on accounts by sending bills or following up with payers via phone, email, fax, mail, or websites; monitor accounts for non-payments, delayed payments, and irregularities.
• Communicate with customers, patients, and providers regarding charges, insurance, payments, invoices, authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends.
• Investigate and resolve customer billing inquiries, including escalated issues and disputes referred by collection agencies.
• Collaborate with internal and external customers to provide authorization status updates and coordinate appeals on denied authorizations; request authorization from state Medicaid programs as needed.
• Reconcile approved authorizations, received documentation, and pending charges to resolve pending/unbilled revenue and ensure orders bill correctly to insurance.
• Analyze required documentation for billing services to ensure compliance with payer requirements.
• Submit daily claims for all eligible/ready status claims and resolve claim rejections promptly to meet payer timely filing requirements.
• Maintain and update physician databases to support accurate billing documentation and communication with physician offices.
• Accurately document authorization requests and follow-up activities for each account.
• Identify trends and root causes of inaccurate private pay billing, report findings to management, and resolve related account errors.
• Maintain extensive knowledge of payer coverage types, insurance policies, payer guidelines, and payer contracts to ensure accurate billing and timely payment.
• Accurately enter and maintain data in the database, including payer information, authorization requirements, coverage limitations, and requalification status.
• Perform other related duties as assigned.

Competency, Skills and Abilities:

• Analytical and problem-solving skills with attention to detail.
• Proficient computer skills and knowledge of Microsoft Office.
• Ability to prioritize and manage multiple tasks.
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.

Requirements

Minimum Job Qualifications:

• High School Diploma or equivalent
• One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

Total Rewards & Benefits Program

• Comprehensive medical, dental and vision coverage (eligible first of the month following hire)
• 401(k) with company match
• Employee Stock Purchase Plan
• Short and Long-term Disability Insurance
• Life and AD&D Insurance
• Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA)
• CVS Minute Clinic and Teledoc access
• Identity Theft Protection and Legal Plan

*Applicable waiting periods apply

Requirements Disclosure

• Company conducted Background Check is required for all roles
• Company conducted Motor Vehicle Record Check is required for driving roles
• Clinical roles require valid licensure/certification, where applicable

In accordance with Florida law, candidates applying for positions located in Florida are required to undergo background screening through the Florida Care Provider Background Screening Clearinghouse, as applicable. As required, we are providing all applicants with access to the Clearinghouse Education and Awareness website: https://info.flclearinghouse.com

In accordance with California law, candidates applying for positions located in California that require on-site presence at a Home Medical Device Retailer (HMDR) facility must obtain a California Department of Public Health (CDPH) Exemptee License. This license requires completion of state-approved training and a course completion certificate, as HMDR facilities are required to have an Exemptee physically present during all hours of operation in lieu of a pharmacist. Applicants must include proof of required training with their license application or disclose their intent to obtain. More information on the CDPH HMDR program and approved training options can be found here: https://www.cdph.ca.gov/Programs/CEH/DFDCS/Pages/FDBPrograms/HomeMedicalDeviceRetailProgram.aspx.

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.