RCM AR Specialist

About This Role

The RCM AR Specialist at Better Life Partners is responsible for managing all workflows related to the back-end billing and collections for medical claims, ensuring efficient processing and adherence to payer regulations.

Responsibilities

• Review denied claims based on assigned markets, payers and work queues within our practice management system
• Accurately and efficiently process requests for denied claims information using website portals and outbound phone calls for all Commercial, Medicare and Medicaid insurance payers
• Research and respond to documentation requests from insurance carriers in a timely manner
• Process appeals of insurance denials and follow-up until the appeal is resolved
• Obtain, review and update patient demographics and insurance information within both EHR and practice management billing system as needed
• Complete timely follow-up on claims submitted to payer, but with no response or ERA after 45 days, to resolve any pending issues within timely filing limits
• Document clear and concise activities performed in the system for each account worked
• Adhere to all HIPAA guidelines and regulations
• Consistently maintain productivity and quality expectations as defined by the leadership team
• Alert management to irregularities, insurance trends and areas of concern with reimbursement

Requirements

• 3+ years experience in physician group practice in a denial management role
• Prior experience resolving out of network denials, and value based (bundle) claims
• Proficient in CPT and ICD-10 coding terminology
• Acute attention to detail
• Strong communication skills
• Ability to work independently

Qualifications

• Bachelor's Degree or Equivalent experience
• 3 or more years of experience in physician group practice in a denial management role

Nice to Have

• Familiar with opioid use disorders, substance abuse use disorders and other areas of behavioral health billing
• Certified Medical Coder, CPC or CCS
• Deep knowledge of medical insurance payers and regulations
• Knowledgeable in healthcare & mental health industries (terminology, regulations, and processes)
• Familiar with all aspects of the RCM Life cycle as it relates to claim reimbursement

Skills

* Required skills