RCM Specialist

RCM Specialist

Full Time - Mon to Friday 9:00 a.m. - 5:00 p.m.

Position Summary:

IN PERSON. The Revenue Cycle Management Specialist will coordinate the Authorizations and Referrals process between Agape and the Insurance plan. Responsible for the Pre-Billing Reviews the Third-party Billing Queues to locate claims that need to be edited/corrected to ensure claims are billed accurately.

Essential Duties and Responsibilities:

1. Analyzes the patient record to determine legitimacy of admission, and treatment.
2. Reviews all Insurance coverage information to request prior authorization in the monthly bases from the Insurance within the established department turnaround time. Routinely communicates with clinical staff and supervisors on all authorization inquiries to reduce the occurrence of non-authorized services.
3. Perform ongoing audits on Billing Queues to establish clean claim billing/adjudication
4. Responsible for timely re-submission and accuracy for billing claims.
5. Reviews claim elements as Credentialing, Authorizations, Coding, and making sure we are billing the correct Insurance. Research balances and takes necessary collection actions=
6. Collaborate and work cross functionally with departments to ensure pre- billing is completed. Identify, analyze, and research the root cause of the denials and underpayments.
7. Staff is responsible to maintain updated insurance information on all patients
8. Collect co-payments, deductibles, and other applicable balances from patients in person or by phone
9. Identify, analyze, and research the root cause of the denials and underpayments.
10. Participates in the continuous quality improvement process.
11. Perform all other duties as assigned or required
12. Assist the department in cross training existing staff, and new hires.

Education and/or Experience:

High school diploma or equivalent 

Familiar with Primary Care billing 

Billing reconciliation 

CPT Codes

Benefits Highlights

Retirement: 403b plan

Balance: Competitive vacation and sick plan, 12 paid Holidays.

Development: Leadership development, personal and professional growth.

Culture: Loved and faith-based mission, respect to diversity; going through expansion and growth.

Who we are:

We are a faith based non-profit organization dedicated to restoring individuals and families to psychological, social, physical, and Spiritual health. You will be working with a team of passionate professionals eager to provide you with the necessary tools and knowledge to succeed and build your career.

Our Mission is to “Restore individuals and families to psychological, social, physical, and Spiritual health.”

Agape Network is an Equal Opportunity Employer and a Drug-Free Workplace.