RCM Specialist Collections

KPH HEALTHCARE SERVICES, INC; Hoffman Estates (IL); On-site; USD 48,000 - 68,000; Full time

Job summary

KPH HEALTHCARE SERVICES, INC. is seeking a Revenue Cycle Management professional to manage collections for outstanding claims and work with insurance companies, patients, and other parties to resolve issues.

The role emphasizes denial resolution, appeals, and maintaining precise records to support company-wide revenue cycle improvements. You will collaborate with internal teams to address challenges, escalate complex cases, and ensure compliance with regulatory standards.

Responsibilities

• Manage the collection process for outstanding claims with contact via phone, email, and written correspondence.
• Investigate and resolve denied or partially paid claims, identifying root causes and 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 within timely filing limits.
• Utilize billing software to maintain accurate records of all collection activities with payers and patients.
• Identify and report trends in claim denials and payment challenges.
• Communicate with patients about billing issues and responses to financial hardship applications.
• Support accurate record-keeping to keep information up-to-date across departments.
• Assist in implementing processes to measure and improve RCM performance.
• Ensure compliance with laws, accreditation standards, and best practices; participate in surveys and committees.

Job description

• 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.