RCM Specialist

RCM Specialist

Position Overview

The role of an RCM Specialist is to call insurances to check claim status, dispute incorrect adjudications and obtain appropriate resolution as per the set guidelines and timelines. They are also responsible for grooming of the team members tagged to them.

Job Functions/Responsibilities

• Understanding various documents from insurances, RCM Processes workflows.
• Understand terminology related to billing, account receivables and denials.
• Analyze claims to understand if it requires calling.
• Prepare the set of questions needed to gather appropriate details of claim status.
• Identify efficient ways to reach insurances faster and get accurate information.
• Call appropriate insurance to gather status of the submitted claims within the set timelines.
• Ensure first time resolution of disputed claims within the set timelines.
• Communicate with practices only through internal portal when necessary.
• Prioritize inventory to avoid delays in resolutions.
• Follow-up with the appropriate insurances to avoid timely filing limit.
• Ensure quality benchmarks are maintained while processing claims.
• Educate, train, and share feedback with tagged team members.
• Ensure that team members maintain consistent performance in the assessments conducted.

Experience/Education Requirements

• Bachelor???s Degree required; Master???s Degree preferred
• Adheres to all company policies and mandatory compliance protocols as required by eCW

Requirements

• Minimum 2 Years of relevant experience is required.
• Industry knowledge of Revenue Cycle Management required.
• Domain specific knowledge in RCM required.

Other Skills/Abilities

Other Skills/Abilities

• Team player attitude.
• Organized with attention to detail.
• Strong verbal and written communication skills.
• Ability to work in a fast-paced work environment.
• Sound analytical and problem ??? solving skills.
• Excellent telephone etiquette.
• Strong computer skills and familiarity with Microsoft Office Tools.

Competencies/KPIs

Competencies

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.