Lead, RCM Specialist

Overview

The Lead, Revenue Cycle Management Specialist is the subject matter expert for insurance payer accounts receivables and will assist the management team with leadership oversight of the RCM domestic and global teams. This individual will provide work assignments, feedback, training, and guidance to ensure RCM staff follow department protocol with RCM processes. The Lead for RCM will handle escalated phone calls from patients or insurance companies that cannot be effectively resolved by offshore staff.

This role will work closely with the supervisor and management to identify payor trends and develop RCM process improvements.

• Mentors guide and provide oversight to the team, with a majority of Adapt Health RCM team members located offshore.
• Apply subject-matter expertise to evaluate business operations and processes.
• Identify areas where technical solutions would improve business performance.
• Consult across teams, provide mentorship, and contribute specialized knowledge.
• Document and implement techniques to streamline production processes.
• Identify team members  strengths and opportunities and report findings to supervisors.
• Respond to internal inquiries for coaching assistance via the subject-matter-expert queue, office communicator, and email.
• Resolve escalations by working with multiple business partners while maintaining clear communication with the member.
• Coach others on how to navigate systems to find information needed for calls.
• As a Subject Matter Expert, assist with training new employees and support other CSRs with issues encountered when interacting with members over the phone; address escalated customer questions and concerns.
• Perform ad hoc deep-dive analyses for specific business problems.
• Train and develop team members to ensure Adapt Health policy and protocol compliance.
• Take escalated phone calls that cannot be resolved by team members.
• Communicate with other departments and front-end staff regarding billing issues and trends to work toward account resolution and reduce insurance denial percentages.
• Handle all insurance payer disputes that are filtered into the department.
• Identify trends and root causes related to inaccurate insurance billing and report to the manager while resolving account errors.
• Conduct team meetings to educate on insurance guidelines, claim denials, and re-training on accounts that were worked incorrectly.
• Develop and enhance process and payer-specific work aids and standard operating procedures.
• Investigate escalated insurance billing inquiries and inaccuracies and take appropriate action to resolve the account.
• Provide quality payer feedback to Adapt Health leadership.
• Develop and maintain a working knowledge of current Adapt Health products and services.
• Maintain patient confidentiality and operate within HIPAA guidelines.
• Complete assigned compliance training and other required educational programs.
• Maintain compliance with Adapt Health’s Compliance Program.
• Perform other related duties as assigned.

• Decision Making
• Strong analytical and problem-solving skills with attention to detail
• Excellent verbal and written communication
• Excellent customer service skills
• Proficient computer skills and knowledge of Microsoft Office
• Ability to prioritize and manage multiple projects
• Strong ability to learn new technologies and understand data flow and system interactions
• Understanding and identifying priority orders
• Extensive knowledge of products offered and required paperwork to bill for those products
• Ability to follow written, oral, or diagram-based instructions

• High School Diploma required;
  Associate degree preferred
• Three (3) years related work experience in health care administrative, financial, insurance, customer services, claims, billing, call center, or management
• Two (2) specific job experiences in HME, Diabetic, home medical supplies, Pharmacy, HH environment is preferred
• Experience in Medicare-certified HME, IV, or HH environment that routinely bills insurance

• The work environment may be stressful at times, with fluctuating activity
• Must be able to bend, stoop, stretch, stand, and sit for extended periods
• Subject to long periods of sitting and computer use
• Ability to perform repetitive motions of wrists, hands, and fingers due to extensive computer use
• Strong ability to convey knowledge and mentor others
• Ability to analyze information, problem-solve, and identify opportunities
• Must be able to lift up to 30 pounds as needed
• Excellent verbal and written communication
• May be exposed to angry or irate customers or patients