RCM Specialist II

2 weeks ago

Rockville, United States Aligned Orthopedic Partners Full time $20 - $25
Job DescriptionJob DescriptionDescription:

RCM Specialist II [Insur A/R, Charge Entry, Refunds]


Who we are:

Aligned Orthopedic Partners is a well-respected private orthopedic team comprised of highly trained, board-certified orthopedic surgeons devoted to delivering the highest orthopedic care possible. Our commitment to finding the best solutions for individual needs sets us apart from the competition. We take pride in providing exceptional care while remaining friendly, courteous, and efficient. Aligned Orthopedic Partners is recruiting for an experienced RCM Specialist II to support billing operations across multiple locations.


PRIMARY RESPONSIBILITIES MAY INCLUDE:


  • Accounts Receivable
  • Prepare and submit electronic and paper insurance claims in a timely manner; prepare and attach all required documentation including referrals, treatment plans or other required correspondence.
  • Review electronic transmission error reports, make corrections, and resubmit in a timely manner; report issues to RCM Manager/Lead as identified and seek assistance in resolution.
  • Have knowledge of the daily processing of assigned billing/AR follow up by provider/facility/payer.
  • Have knowledge of how to work denials/rejections immediately based on assigned accounts to ensure timely response and avoid timely filing issues.
  • Respond to insurance inquiries in a timely fashion; prepare billing correspondence; maintain all billing related documents per protocol – seek assistance from Team Lead or Manager as needed.
  • Report accounts receivable activities and reimbursement trends weekly to Team Lead or Manager.


  • Charge Entry
  • Accurately post charges in a timely manner; ensure completeness of charges; obtain missing information and expedite processing to optimize revenue cycle performance.
  • Research, analyze, recommend, and facilitate plans to correct discrepancies and prevent future charge entry errors.
  • Identify reportable elements, complications, and other procedures.
  • Research missing encounters monthly.


  • Refunds
  • Work credit balances per Refunds Policy
  • Review refund requests daily for completeness by comparing documentation against specific facility fee schedules and with various payers.
  • Prepare Refund Request Forms and supporting documentation regarding overpayment calculations and submit refund requests in good order for approval.
  • Compile, send necessary documentation, and post within 24-48 hours.
  • Daily/weekly/monthly balancing of all posting activity performed.
  • Perform follow-up on checks that have not cleared the bank and research checks that are returned for insufficient address.
  • Identify and share payment/adjustment trends with RCM leadership to help train RCM personnel.
  • General
  • Check designated voicemail throughout the day to ensure prompt follow up.
  • Perform designated functions required for accurate daily close of the billing system.
  • Work collaboratively with peers to cover workloads, special projects, and other duties.
  • Work with all other functional areas of the Revenue Cycle Management team, including EDI/claims, charge posting, payment posting and patient accounts.
  • Communicate all issues or potential issues to leadership.
  • Assist in preparation of practice summary reports, as requested or assigned.
  • Attend regularly scheduled business office meetings; assist in identifying “best coding and billing practices” to ensure appropriate reimbursement.


POSITION REQUIREMENTS:

  • High School Diploma
  • At least two years of applicable experience
  • Able to multi-task and capable of remaining calm in a stressful situation
  • Able to use a multi-line telephone system and the billing computer program
  • Familiarity with federal, state, and commercial insurance guidelines and policies preferred
  • Excellent written, verbal, and interpersonal communication skills.
  • Proficiency with Microsoft Excel and Word
  • Accurate and efficient data entry skills
  • Strong attention to detail
  • Proficient computer software and database skills.
  • Strong analytical skills.
  • Demonstrates working knowledge of medical terminology, diagnostic and procedural coding, and the medical billing process
  • an RCM Specialist II cross-trained and routinely performing two of the three primary responsibility functions listed above (other than General) may be considered for an RCM Specialist III position


What we offer:

We strive to enrich the lives of our team and offer a variety of health and wellness benefits including medical and dental benefits, employer-paid short-term and long-term disability coverage, a matching 401K program, generous paid time off, and an environment that celebrates continuous learning and development.

Equal Opportunity Employer

Aligned Orthopedic Partners is an equal-opportunity employer. We promote diversity of thought, culture, and background. We celebrate what makes us different and are committed to building a team that represents a variety of experiences. All employment is decided on the basis of qualifications, merit, and business need.



Requirements:


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