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RCM System Setup in Miami, FL at Health Choice Network, Inc.

Date Posted: 6/27/2018

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.

 

POSITION PURPOSE:

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

 

JOB RESPONSIBILITIES:

  • Executedaily financial closing for HCN RCM participating members.
  • MonitorInterfaces related to charges and demographics in association with PMapplications.  Complete/coordinatecorrections/updates.
  • Prioritizeand complete incoming requests via ChangeGear. Coordinate and communicate with members and supporting team members viaelectronic, phone conference.
  • 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.
  • Monitorsystem wide setup standards for all RCM member centers including, but notlimited to, insurance plans, provider files, service files, fees schedules andprofiles, diagnosis codes, procedure codes, and ERA parameters.
  • Prepareall recurring fee updates and communications to member centers.
  • 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.
  • Participatein generation and Quality Assurance of analytical information supportingfinancial, encounter and Quality based reporting measures.
  • Researchand testing of POMIS system tools and parameters assisting with defining anddevelopment of HCN Best Practices.
  • 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
  • Otherduties may be assigned.

 

KNOWLEDGE, SKILLS AND ABILITIESREQUIRED FOR THIS POSIITON:

  • 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, dental and/orbehavioral health.
  • Analyticalskills, time management, written & verbal skills.
  • FQHCbilling knowledge.

 

EDUCATION, EXPERIENCE AND CERTIFICATIONS:

  • 2years of experience in s billing or claims analyst position and/or Associate’sDegree in Accounting, Finance, MIS, Healthcare Administration, BusinessAdministration or related field or equivalent combined experience.
  • Minimumof 2 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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