RCM Administrator

POSITION SUMMARY:

The RCM Administrator, a key position in the revenue cycle, manages the claims process, including

accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries.

The incumbent will assist in the clarification and development of process improvements and inquiries,

assure payment for services rendered are recorded, reconciled timely, and posted accurately.

DUTIES RESPONSIBILTIES

BILLING AND CLAIMS:

· Prepares and submits clean claims to third party payers either electronically or on paper.

· Properly attends to all clearinghouse reports to clear rejections accurately · Ensures all eligibility

rejections are properly researched and corrected.

· Attends to all requirements for secondary billing protocols.

· Submits resubmissions, evaluating root cause and escalating any trends. · Communicates effectively

with each practice regarding insurance issues.

· Alerts practice staff of open balances by properly documenting in eClinicalWorks. · Identifies and

resolves all billing problems, keeping management informed. · Uses the alert system in eClinicalWorks

to communicate any coding errors. · Maintains the strictest confidentiality, adhering to all HIPAA

regulations.

COLLECTIONS:

· Follows collection protocols for assigned accounts (follow up metrics, etc.) · Maintains worklist

ensuring each patient account has been reviewed timely. · Monitors payments, accessing payor

portals regularly for claim status.

· Follows third party rules regarding balance billing.

· Identifies denials, determines root cause, performs appeals.

· Escalates trendy denials to management for further research.

· Provides information to management regarding uncollectable account balances. · Adheres to KPI

metrics for Collection percentages, AR aging, Denial Management, etc.

· Reviews ERA’s and EOB’s as necessary, reporting posting errors to management. OTHER:

· Actively participates in department staff meetings.

· Keeps abreast of changes in payor regulations and updates.

· Follows departmental Policy and Procedures at all times.

· Willingness to assist other areas in the RCM department when needed.
JOB REQUIREMENTS:

· Knowledge of medical billing/collection practices required.

· Excellent billing/collections software expertise, preferably with eClinicalWorks.

· Works well in fast-paced, high volume environments with firm deadlines. · Results oriented.

· Possesses the ability to multi-task.

· Able to work both independently and as part of a team.

· Strong analytical skills required.

· Capable of making good independent decisions.

QUALIFICATIONS/ REQUIREMENTS

• High school diploma or general equivalency diploma (GED

SAFETY HAZARD OF THE JOB

Minimal Hazards