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RCM Primary Care Claims Specialist

2 months ago

Rio Rancho, New Mexico, United States UMC Health System Full time
About the Job

The RCM Primary Care Claims Specialist plays a vital role in ensuring the accuracy and timeliness of initial third-party and government claims. This position involves handling unpaid, rejected, or denied claims, including following up or appealing as needed.

Key Responsibilities
  • Obtain missing information and research denials and documentation
  • Ensure timely follow-up on claims
  • Take necessary actions to resolve rejected, underpaid, and denied claims promptly
  • Review and resolve coding denials for primary care providers
  • Identify and address claim issues impacting revenue cycle
  • Contact payers for claims reimbursement
  • Interpret medical rules and policies for accurate reimbursement
  • Maintain compliance with standards and policies
Requirements
  • High School diploma or equivalent
  • 2 years of medical billing or collections experience
  • Type 40 wpm, 10-key by touch
  • Strong attention to detail
Preferred Qualifications
  • Knowledge of carrier-specific claims appeal guidelines
  • Strong analytical and decision-making skills
  • Familiarity with CPT and ICD-10 codes
  • Experience with denial management in primary care
Work Environment

This position is located in a professional office environment with low-risk exposure to bloodborne pathogens.