RCM Billing Specialist

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Prepare, review, and submit clean, error-free claims to insurance payers.
• Follow up on denied or rejected claims to secure reimbursement.
• Process claims showing amounts billed to insurance companies and to patient and miscellaneous adjustments.
• Talk with patients about their Slocum clinic or ASC medical bill, via phone, in person or patient portal.
• Manage patient accounts, calculate intake costs, and arrange payment options.
• Answer patient questions regarding their Slocum statements in person, via phone or patient portal.
• Refund over payment of claims either to the patient or the insurance company.
• Compute total bills showing amounts billed to insurance company and to patient.
• Verify patient’s coverage via website or telephone and to obtain information concerning extent of benefits.
• Telephone, write or message via website companies with unpaid insurance claims to obtain settlement of claim.
• Verify OHP Line Finder Code.
• Work denied insurance claims via letter, website or call
• Manage the private insurance A/R.
• Create estimates via Experian as well as manually as needed.
• Communicate cross-functionally with providers and other Slocum departments regarding patient questions or billing concerns

• Strong knowledge of medical coding (ICD-10, CPT), terminology, and insurance regulations
• Billing and/or Coding experience.
• Experience working with Electronic Health Records.
• Be able to read and understand digital and paper insurance Explanation of Benefits.
• Tobe professional and courteous
• Able to multi task
• Prioritize work load daily, weekly and monthly
• Have high accuracy and efficiency
• Communicate clearly, concisely and courteously via phone, email and in person
• Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.
• Able to sit or stand for long periods of time.
• Be able to work on a computer and keyboard for up to eight hours a day.
• Able to walk, and use hands to finger, handle, or feel. Able to reach with hands and arms.
• Ability to hear and understand in person and over the phone.
• Able to speak and provide information in person and over the phone.

• This position is designated as a Category 3 employee that does not perform tasks that involve exposure to blood, body fluids, or tissue.

• Medical insurance knowledge and background required.
• High school diploma or GED or equivalent experience and training required.
• Previous experience as an RCM Billing Specialist or related experience with patient billing, collections, and/or coding.
• Previous experience working with Electronic Health Records.

The RCM Billing Specialist is responsible for managing the financial lifecycle of patient care, ensuring that insurance payer reimbursements are accurate and timely. This overall goal is achieved through verifying patient information, submitting and tracking appealed claims, and resolving claims denials.