RCM Primary Care Follow Up Specialist
3 weeks ago
We are seeking a highly skilled RCM Primary Care Follow Up Specialist to join our team at UMC Health System. As a key member of our revenue cycle team, you will play a critical role in ensuring that all initial third-party and federal/state government claims are billed and all unpaid, rejected, or denied claims receive appropriate follow-up or an appeal to overturn the denial as required.
Key Responsibilities:- Take action to resolve rejected, underpaid, and denied claims by submitting corrected claims and appeals on a timely basis upon review of unpaid encounters.
- Review, research, and resolve coding denials for primary care providers, including denials related to the billed CPT, diagnosis, or modifier.
- Identify and resolve complex claim issues adversely impacting the revenue cycle to achieve resolution, requiring coordination with clinical departments and payers through clear and concise written and oral communication.
- Identify denial, payment, and coding trends to decrease denials, improve denial prevention, and maximize collection.
- Contact payers via website, phone, or correspondence regarding reimbursement of claims denied.
- Interpret medical rules and policies, including payor-specific requirements such as Medicaid and Medicare, to ensure proper reimbursement.
- Maintain compliance with department standards, HIPAA, and governing agency policies and procedures.
- High School diploma or equivalent.
- 2 years of medical billing or collections experience (combination of higher education and work history may be considered to satisfy this requirement).
- Type 40 wpm, 10 key by touch.
- Strong attention to detail.
- Knowledge of carrier-specific claims appeal guidelines, including claim logic, electronic, and paper/fax processes.
- Proven analytical and decision-making skills to determine what selective clinical information must be submitted to properly appeal the denial.
- Knowledge of CPT and ICD-10 codes.
- Ability to read and interpret chart notes to determine appropriate denial resolution based on documentation.
- Denial management, billing, coding guidelines.
- Previous experience with denials and follow-up in primary care.
- Prolonged sitting, some bending, lifting, stooping, and stretching.
- Hand-eye coordination and manual dexterity sufficient to operate a keyboard, copier, telephone, adding machine, fax machine, printers, and other minor office equipment.
- Normal range of hearing and eyesight to record, prepare, and communicate appropriate reports.
- Must be able to communicate in person, via voicemail, telephone, and e-mail.
Works in a well-lighted, heated, and ventilated building. Professional office environment. Exposure to blood-borne pathogens is of low risk.
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