RCM Specialist; Billing and Reimbursements

Overview

RCM Specialist (Billing and Reimbursements) – Minneapolis, MN, USA

Job Description posted Tuesday, June 1, 2021 at 4:00 AM. Adapt Health is a premier full-service home medical equipment company in the United States offering a full-scope of cost-efficient HME and respiratory care products and services that aim to keep patients comfortable and thriving in their own homes. We are dedicated to pursuing better outcomes through technology, process, and our national network.

We are committed to innovation to transform the durable medical equipment industry and provide the best quality care.

Position Summary: The RCMSpecialist is responsible for maintaining a timely revenue cycle for all goods and services provided by Adapt Health. Also responsible for maintaining patient confidentiality and functioning within HIPAA guidelines. Completes assigned compliance training and other educational programs as required. Maintains compliance with Adapt Health’s Compliance Program.

Essential Functions and

Job Responsibilities:

• Ensure organization receives accurate payment for goods & services provided according to contracted rates and/or payer fee schedules.
• Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites.
• Reconcile the accounts receivable to ensure that all payments are accounted for and properly posted.
• Investigate and resolve customer inquiries regarding charges.
• Monitor patient account details for non-payments, delayed payments, and other irregularities.
• Communicate with customers regarding insurance, payments, and invoices.
• Research and resolve payment discrepancies.
• Identify and verify that billing complies with policies and procedures.
• Identify trends and root causes related to inaccurate payments and escalate as appropriate.

• Analyze daily requests to determine coverage and approval utilizing criteria.
• Utilize clinical staff for medical reviews when necessary.
• Notify staff when authorization is approved or denied.
• Collaborates with internal & external customers to provide status updates & coordinate appeals on denied authorization.
• Resolves pending revenue by reconciling approved authorizations and pending charges.

• Ensure order will bill correctly to insurance.
• Ensure order has valid proof of delivery.
• Address messages on sales orders.
• Correct messages as needed.
• Process order to correct WIP state or confirm order.

• Responsible for the daily claims submissions/printing for all eligible/ready status claims.
• Resolves all claim rejections in a timely manner to guarantee submission within the timely filing requirements of the payers.
• Identifies claim rejections and escalates as appropriate to facilitate educational opportunities or process improvements.
• Maintains daily, weekly, monthly system/database functions and performs routine functions as defined by leadership.

• Analyze documentation required for billing services and ensure compliance to payer requirements.
• Resolve pending revenue by reconciling received documentation and pending charges.
• Requests authorization from state Medicaid programs.
• Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices.
• Completes accurate documentation of authorization request and follow up activities on each account.
• Ensures proper payer and system follow up procedures are performed for accurate authorization tracking.
• Performs extensive account audits and ensures proper billing for services to the accurate payer.
• Ensures proper revenue recognition for billed charges and services moving forward.
• Completes all assigned requalification within the set 75-day time frame by having patients retested, picking up equipment when appropriate, or executing ABNs and setting patients up on autopay.
• Investigate and resolve customer, patient, or physician office concerns regarding questions while working with the patient through the requalification process.
• Establish and maintain relationships with key individuals in the regions to support the requalification process, setting clear expectations of what is required by the region.
• Identify trends and root causes related to inaccurate private pay billing, and report to manager while resolving account errors.
• Investigate escalated customer billing inquiries and take appropriate action to resolve the account.
• Resolve private pay charges for returned payments due to returned payments.
• Resolve accounts pertaining to patient account inaccuracies or patient demographics.
• Respond to collection agencies regarding patient disputes of balances owed on accounts.
• Enroll patients calling regarding financial responsibility and enroll in autopay.

• Educate patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends.
• Maintain an extensive…