RCM Specialist

About Us – Mission & Values

At All In Solutions, our mission is to provide quality, evidence-based treatment that leads to long-term recovery for every client who walks through our doors. We believe that connection and purpose are essential to this pursuit, guiding every decision we make and every service we provide.

Position Summary

Join our team as a Revenue Cycle Management (RCM) Collections Specialist. You will be essential in ensuring timely payment by reviewing, resolving, and appealing unpaid and denied claims. This role requires strong experience with RCM collections (2+ years) and mandatory proficiency in CollaborateMD and KIPU EMR. Key duties include investigating billing discrepancies, communicating with insurance companies, tracking denial trends, and maintaining compliance with payer guidelines.

Work Location

• We have hybrid and fully on-site opportunities available at our new corporate office in Boynton Beach, FL

Essential Duties and Responsibilities

• Reviews and works on unpaid claims, identifying and rectifying billing issues.
• Assists with follow up on claims processed to ensure payment to the agency.
• Use of KIPU EMR and CollabMD Billing Software to review patient chart and claims using CollabMD to document Patient notes, Patient statements, Patient balances
• Communicates with insurance companies regarding any discrepancy in payments if necessary.
• Conducts research and appeals denied claims timely.
• Reviews Explanation of Benefits (EOBs) to determine denials or partial payment reasons.
• Responsible for investigating insurance rejected claims and the re-processing of denied claims and/or appeals of denied or underpaid claims.
• Provides detailed notes on actions taken and next steps for unpaid claims.
• Collaborates with the billing team to ensure accurate claim submission.
• Work with UR regarding patient insurance authorization, if denied or non covered level of care
• Maintains a comprehensive understanding of the insurance follow-up process, payer guidelines, and compliance requirements.
• Identify denial patterns, as well as notifying senior management of payment delay issues.
• Resubmits claims with necessary corrections or supporting documentation when needed.
• Knowledge of Third Party payers, billing requirements and reimbursement methods; knowledge of medical terminology.
• Audit accounts that have open claims - investigate and resolve as necessary.
• Tracks and documents trends related to denials and work towards a resolution with the billing team.
• Contacts insurance companies via phone regarding outstanding accounts.
• Verify that insurance is paying claims at the correct fee schedule.
• Assists patients with inquiries related to their insurance claims, providing clear and accurate information.
• All other duties as assigned.

Qualifications

• High school diploma or equivalent required.
• Experience in accounts receivable collections or a similar role in a Behavioral
• Health industry specializing in Substance abuse and Mental Health is strongly preferred.
• Knowledge of medical terminology, CPT and ICD-10 coding is a plus.
• Knowledge of HIPAA and other healthcare industry regulations.

Required Skills/Abilities

• Must have experience with Collaborate MD, and KIPU
• 2+ years of RCM collections experience in a healthcare setting
• Strong analytical, organizational, decision making and multitasking skills.
• Be able to prioritize daily work
• Experience in collecting outstanding balances
• Excellent verbal and written communication abilities.
• Ability to navigate payer websites and use online resources to resolve outstanding claims.