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RCM Specialist I in Miami, FL at Health Choice Network, Inc.

Date Posted: 6/26/2018

Job Snapshot

Job Description

Health Choice Network is committed to provide exceptionalcustomer service that exceeds the expectation of those we service.  Eachand every employee at HCN is expected to possess the ability to inspireconfidence, display a constructive attitude, make ethical business decisions,and represent the company well in all aspects of customer service.


Thisposition is responsible for the day to day practice management support, filemaintenance, and monitoring of KPI’s relative to Revenue Cycle Management.


  • MonitorRevenue Cycle Management A/R trends specific to denials and rejections.
  • Identifyand analyze claim rejection/denial trends for each clearinghouse/payor andresolve root-cause billing issues by working with the supervisor, billingstaff, and payors as needed
  • MonitorInterfaces related to charges and demographics in association with PMapplications.  Complete and coordinatecorrections/updates.
  • Prioritizeand complete incoming requests via ChangeGear. Coordinate and communicate with members and supporting team members viaelectronic email and or phone conference. Use all available resources to manageticket escalation.
  • MaintainPM billing support files including, but not limited to, insurance plans,provider files, service files, fees schedules and profiles, diagnosis codes,procedure codes, and ERA parameters.
  • Participatein RCM Vendor conference calls as touchpoints to identify opportunities forsystem optimization
  • Participatein development, generation and Quality Assurance of analytical informationsupporting financial, encounter and Quality based reporting measures.
  • Researchand testing of POMIS system tools and parameters assisting with defining anddevelopment of HCN Best Practices.
  • Developdocumentation supporting Best Practice in POMIS application.
  • Developdocumentation supporting training initiatives in POMIS application.
  • Developdocumentation for member centers associating required system actions inaccordance with payor  and/or softwareupdates.
  • Keepscurrent with payor billing/payment rules, EDI tools and EDI transactionrequirements
  • Executedaily financial closing for HCN RCM participating members.
  • Otherduties may be assigned.



  • Strongcustomer service skills; prompt return and follow up to all interactions;prompt response to requests for information
  • Knowledgeof Professional and UB04 billing, electronic claims processing, CPT &ICD9/10, HCPCS, CDT coding, medical terminology and compliance rules.
  • Knowledgeof Microsoft Office applications including Word, Excel, and Outlook.
  • Knowledgeof billing and accounts receivable systems.
  • Knowledgeof Healthcare and Community Health Center industry and practices.
  • Knowledgeof healthcare contract terms, preferably for primary care, vision, dentaland/or behavioral health.
  • Analyticalskills, time management, written & verbal skills.
  • FQHCbilling knowledge.


  • 2years of experience in s billing or claims analyst position and/or Associate’s Degreein Accounting, Finance, MIS, Healthcare Administration, Business Administrationor related field or equivalent combined experience.
  • Minimumof 3 years’ healthcare billing and collection experience.

Health Choice Network is an equalopportunity/affirmative action employer and complies with all federal and statelaws, regulations and executive orders regarding affirmative actionrequirements in all programs.

HCN is a drug-free workplace.


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