RCM / Collections Specialist / Medical Biller

About the Role

Responsible for the timely, accurate submission of invoices to responsible payer, of any type, for all services and products provided. Evaluates payments received and application to the patient account. Follows-up with responsible parties to ensure the receipt of timely, accurate payments. Assists with Billing and Collection Training and completes "second level" appeals to payers.

Key Responsibilities

• Submits timely, accurate invoices to payer for products and services provided.
• Understands the terms and fee schedule for all contracts for which invoices are submitted.
• Correctly determines quantities and prices for drugs billed.
• Verifies that the services and products are correctly authorized and that required documentation is on file.
• Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.
• Evaluates payments received for correctness and applies payments accurately to the system.
• Verifies that payments received are correct according to the fee schedule.
• Applies the payment correctly to the patient account.
• Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment.
• Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service.
• Transfers payments belonging to other offices within 48 hours of receipt.
• Follows up on invoices submitted to ensure prompt and timely payment.
• Calls to verify that claims submitted were received and are in processing.
• Sends letters to the patient or responsible party when their insurance carrier fails to make payment within a reasonable timeframe.
• Generates and mails statements and collections letters.
• Follows up on all denials within 48 hours of receipt.
• Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule.
• Follows HIPAA guidelines when accessing and sharing patient information to maintain patient and business confidentiality.

Requirements & Tech Stack

• Basic level skill in Microsoft Excel
• Basic level skill in Microsoft Word

Qualifications

• High School Diploma or equivalent.
• 0 – 6 months previous Infusion Reimbursement or Intake/Admissions experience.
• Applicants must currently reside in the Mountain OR Pacific Time Zone.