RCM Billing Specialist

Description

POSITION:  RCM Billing Specialist

RESPONSIBLE TO: RCM Supervisor, Billing

JOB SUMMARY:  This position will be responsible for scrubbing claims for accuracy in billing. The Scrubbing department will be charged with retrieving, approving, batching, and scrubbing claims to avoid errors that would cause the claim to reject or deny.

RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:

• Retrieve claims from the Electronic Medical Records (EMR).
• Review EMR documentation where appropriate.
• Diagnosis coding for known appropriateness for the visit and for the carrier guidelines.
• Ensure charges, diagnosis pointers, modifiers, and NDCs (if necessary) are correct and there are no duplicates.
• Ensure that the correct provider, site, insurance, filing type, and referrals/authorizations are selected.
• Work exceptions caught by system scrubbing.
• Work Front End Rejections.
• Communicate with appropriate person(s) with any questions or concerns. This could include - but not limited to - hub personnel, provider, coding team and others within the CBO.
• Approve and batch claims.
• Periodically check for Unretrieved Charges.
• Communicate with others of observed trends.
• Recognizing the need for additional scrub rules based on trends.

OTHER

• Ability to work independently and as part of a team with the capability to shift between projects while maintaining productivity and efficiency.
• Attends Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.
• Maintain patient confidentiality, comply with HIPAA and compliance guidelines established by the practice to protect RCM operations by keeping information confidential.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends all meetings as requested including regular staff meetings.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards, and policies.
• All other projects and duties as assigned.

SUPERVISORY RESPONSIBILITIES

This position does not have any supervisory duties.

TYPICAL PHYSICAL DEMANDS

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. Position requires prolonged sitting, some bending, stooping, and stretching. Good eye -hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.

Qualifications

EDUCATIONAL REQUIREMENTS:

• High school diploma, or equivalent, required.

QUALIFICATIONS AND EXPERIENCE:

• Minimum eighteen months experience in a medical office reimbursement department.
• Comfortable using email and interacting with Internet applications.
• Working knowledge of MS Excel, MS Word, and understanding of practice management software.
• Basic understanding of Explanation of Benefits forms, claim forms and the insurance billing process.
• Strong written and verbal communication skills.