Revenue Cycle Management Specialist

2 weeks ago

Oklahoma City, OK, United States KPH Healthcare Services, Inc. Full time

Overview

The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances.

Responsibilities

  • Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.

  • Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.

  • Collaborate with internal teams to address claims challenges and improve revenue cycle.

  • Escalate complex or uncollectible accounts to management for further action.

  • Submit appeals/claim corrections as needed within timely filing limits.

  • Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.

  • Payer projects as assigned.

  • Identify and report trends in claim denials and payment challenges.

  • Communicateasneededwithpatients about billing issues,including theresults ofapplications for financial hardshipassistanceand other responses tocustomerinquiries about

  • Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.

  • Assist in the implementation of processesto measure,assess,and improve the performance of the RCM departmentactivities of thecompany.

  • Ensure ongoingcompliance with alllawsandregulations;ensurethat the department meets orexceedsaccreditation standards; and implement "best practices" in all departmental

  • Participate insurveysconductedby authorized inspection

  • Participate in the company's Performance Improvement program as requested by thePerformance Improvement

  • Participate incompany committees when

  • Participate in in-service education programsprovided by the company.

  • Pursuecontinuing education programs appropriateto job

  • Performotherduties as assigned by

  • Complete all mandatory and regulatory training programs.

  • Reportanymisconduct,suspicious orunethicalactivitiesto the Compliance

  • Complies with accepted professional standards and practice.

Qualifications

Job Skill Requirements:

  • Ability to read and interpret medical records for billing purposes.

  • Competent in mathematic equations.

  • Ability to compute unit conversions for drugs.

  • Understanding of CPT, HCPCS, ICD-10, and NDC codes

  • Diligent attention to detail.

  • Excellent verbal and written communication.

  • Understanding of HIPAA compliance.

  • Self-directed, has the ability to work with little supervision.

  • Proficiency in Excel, Outlook, and all other office applications.

  • Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)

  • Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.

  • Deep understanding of home infusion process, therapies, and related services.

  • Ability to understand payer explanation of benefits.

Educational Requirements:

  • High school diploma or GED

Experience:

  • One to three years of experience in Home Infusion or Specialty Pharmacy collections.

Connect With Us (https://kphcareers-kphhealthcareservices.icims.com/jobs/13807/revenue-cycle-management-specialist---collections/job?mode=apply&apply=yes&in_iframe=1&hashed=-336031866)

Job Locations US-OK-Oklahoma City

Posted Date 9 months ago (2/15/2025 3:22 PM)

Requisition ID 2025-13807

# of Openings 1

Category Accounting/Finance

Location : Location US-OK-Oklahoma City

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