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

Date Posted: 8/26/2018

Job Snapshot

Job Description

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


POSITION PURPOSE:

This position is responsible for the day to day practice management support, file maintenance, and monitoring of KPI’s relative to Revenue Cycle Management.


JOB RESPONSIBILTIES:

  • Monitor Revenue Cycle Management A/R trends specific to denials and rejections.
  • Identify and analyze claim rejection/denial trends for each clearinghouse/payor and resolve root-cause billing issues by working with the supervisor, billing staff, and payors as needed
  • Monitor Interfaces related to charges and demographics in association with PM applications.  Complete and coordinate corrections/updates.
  • Prioritize and complete incoming requests via ChangeGear.  Coordinate and communicate with members and supporting team members via electronic email and or phone conference. Use all available resources to manage ticket escalation.
  • Maintain PM 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.
  • Participate in RCM Vendor conference calls as touchpoints to identify opportunities for system optimization
  • Participate in development, generation and Quality Assurance of analytical information supporting financial, encounter and Quality based reporting measures.
  • Research and testing of POMIS system tools and parameters assisting with defining and development of HCN Best Practices.
  • Develop documentation supporting Best Practice in POMIS application.
  • Develop documentation supporting training initiatives in POMIS application.
  • Develop documentation for member centers associating required system actions in accordance with payor  and/or software updates.
  • Keeps current with payor billing/payment rules, EDI tools and EDI transaction requirements
  • Execute daily financial closing for HCN RCM participating members.
  • Other duties may be assigned.

 

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED FOR THIS POSITION:

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

EDUCATION, EXPERIENCE AND CERTIFICATIONS:

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

Health Choice Network is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations and executive orders regarding affirmative action requirements in all programs.

HCN is a drug-free workplace.



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