RCM Specialist Collections

KPH Healthcare Services Inc.; Hoffman Estates (IL); Presencial; USD 45 000 - 65 000; Tempo integral

Resumo da oferta

Priority Dispatch Corp. is seeking a detail-oriented collections specialist to support Home Infusion and Specialty Pharmacy revenue cycle management. You will contact insurers, patients, and other parties to collect on claims and address denials.

You will review CPT/HCPCS/ICD-10 coding, ensure HIPAA compliance, and use Excel and pharmacy software to document all actions. Collaboration with internal teams is essential to improve outcomes.

Qualificações

• Read and interpret medical records for billing purposes.
• Understand CPT, HCPCS, ICD-10, and NDC codes.
• Ensure HIPAA compliance and accurate documentation.

Responsabilidades

• Manage the collection process for outstanding claims via phone, email, and written correspondence.
• Investigate denied or partially paid claims and implement corrective actions.
• Collaborate with internal teams to improve revenue cycle and reduce denials.
• Submit appeals/claim corrections within timely filing limits.
• Maintain accurate records of all collection activities in billing software.
• Identify trends in claim denials and payer payment challenges.
• Communicate with patients about billing issues and financial hardship options.
• Ensure compliance with laws and accreditation standards.

Conhecimentos

Medical billing

Denials management

Excel

Outlook

Communication

HIPAA compliance

Self-directed

Attention to detail

Pharmacy terminology

Formação académica

High school diploma or GED

Ferramentas

CPR+

Wellsky

CareTend

Descrição da oferta de emprego

Job Duties:Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.Collaborate with internal teams to address claims challenges and improve revenue cycle.Escalate complex or uncollectible accounts to management for further action.Submit appeals/claim corrections as needed within timely filing limits.Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.Payer projects as assigned.Identify and report trends in claim denials and payment challenges.Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about billing.Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.Assist in the implementation of processes to measure, assess, and improve the performance of the RCM department activities of the company.Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement \"best practices\" in all departmental activities.Participate in surveys conducted by authorized inspection agencies.Participate in the company's Performance Improvement program as requested by the Performance Improvement Coordinator.Participate in company committees when requested.Participate in in-service education programs provided by the company.Pursue continuing education programs appropriate to job responsibilities.Perform other duties as assigned by supervisor.Complete all mandatory and regulatory training programs.Report any misconduct, suspicious or unethical activities to the Compliance Officer.Complies with accepted professional standards and practice.Job Skill Requirements:Ability to read and interpret medical records for billing purposes.Competent in mathematic equations.Ability to compute unit conversions for drugs.Understanding of CPT, HCPCS, ICD-10, and NDC codesDiligent attention to detail.Excellent verbal and written communication.Understanding of HIPAA compliance.Self-directed, has the ability to work with little supervision.Proficiency in Excel, Outlook, and all other office applications.Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.Deep understanding of home infusion process, therapies, and related services.Ability to understand payer explanation of benefits.Educational Requirements:High school diploma or GEDExperience:One to three years of experience in Home Infusion or Specialty Pharmacy collections.