RCM Specialist (Billing and Reimbursements)

AdaptHealth is a premier full-service home medical equipment company in the United States - offering a full-scope of cost-efficient HME and respiratory care products and services that aim to keep patients comfortable and thriving in their own homes. We are dedicated to pursuing better and use technology, process and the power of our national network to do so.  We have a relentless commitment to using innovation to transform the durable medical equipment industry, break the status quo and provide the best quality care. 
 

Position Summary:

The RCM Specialist is responsible formaintaining a timely revenue cycle for all the goods and services provided by AdaptHealth.Also responsible for maintaining patient confidentiality and function within the guidelines of HIPAA. Completes assigned compliance training and other educational programs as required. Maintains compliant with AdaptHealth's Compliance Program.

Essential Functions and Job Responsibilities:

Account Receivable  

• Ensure organization receives accurate payment for goods & services provided according to contracted rates and/or payer fee schedules.  
• Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites.  
• Reconcile the accounts receivable to ensure that all payments are accounted for and properly posted.  
• Investigate and resolve customer inquiries regarding charges. 
• Monitor patient account details for non-payments, delayed payments, and other irregularities.  
• Communicate with customers regarding insurance, payments, and invoices.  
• Research and resolve payment discrepancies.  
• Identify and verify that billing complies with policies and procedures.  
• Identify trends and root causes related to inaccurate payments and escalate as appropriate.  

Authorization 

• Analyze daily requests to determine coverage and approval utilizing criteria. 
• Utilize clinical staff for medial reviews when necessary. 
• Notify staff when authorization is approved or denied. 
• Obtain & enter authorization into database timely & accurately. 
• Collaborates with internal & external customers to provide status updates & coordinate appeals on denied authorization. 
• Resolves pending revenue by reconciling approvedauthorizations and pending charges. 

Confirmation 

• Ensure order will bill correctly to insurance.  
• Ensure order has valid proof of delivery. 
• Address messages on sales order 
• Correct messages as needed. 
• Process order to correct WIP state or confirm order.  

Data Support 

• Responsible for the daily claims submissions/printing for all eligible/ready status claims 
• Resolves all claim rejections in a timely manner to guarantee submission within the timely filing requirements of the payers. 
• Identifies claim rejections and escalates as appropriate to facilitate educational opportunities or process improvements. 
• Maintains daily, weekly, monthly system/database functions and performs routine functions as defined by leadership. 

Unbilled Revenue 

• Analyzedocumentation required for billing services and ensure compliance to payer requirements. 
• Resolve pending revenue by reconciling receiveddocumentationand pending charges. 
• Requests authorization from state Medicaid programs. 
• Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices. 
• Completes accurate documentation of authorization request and follow up activities on each account. 
• Ensures proper payer and system follow up procedures are performed for accurate authorization tracking. 
• Performs extensive account audits and ensures proper billing for services to the accurate payer.  
• Ensures proper revenue recognition for billed charges and services moving forward.  
• Completes all assigned requalification within the set 75-day time frame by having patients retested, picking up equipment when appropriate, or executing ABNs and setting patients up on autopay.  
• Investigate and resolve customer, patient, or physician office, concerns regarding questions while working with the patient through the requalification process.  
• Establish and maintain relationships with key individuals in the regions to support the requalification process setting clear expectations of what is required by the region. 

Patient Financial Services  

• Identify trends and root causes related to inaccurate private pay billing, and report to manager while resolving account errors.  
• Investigate escalated customer billing inquiries and take appropriate action to resolve the account. 
• Resolve private pay charges for returned payments due returned payments.  
• Resolve accounts pertaining to patient account inaccuracies or patient demographics. 
• Respond to Collection agency regarding patient disputes of balances owed on accounts. 
• Enroll patients calling regarding financial responsibility and enroll in autopay. 

All RCM Specialist responsibilities: 

• Educate patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, andinsurancechanges or trends. 
• Maintains an extensive knowledge of different types of payer coverage, insurance policies, payer guidelines and payer contracts ensure accurate Billing and timely payment is received.  
• Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification. 
• Collaborates withphysicianoffices, AdaptHealth sales and support staff to ensure timely receipt of documentation as well as educating, as necessary.  
• Identify trends and providing feedback andeducationto internal and external customers on compliantdocumentationrequirements for services provided. 
• Performs other related duties as assigned. 

Competency, Skills and Abilities:

• Decision Making 
• Analytical and problem-solving skills with attention to detail 
• Strongverbal and written communication 
• Excellent customer service skills 
• Proficient computer skills and knowledge of Microsoft Office 
• Ability to prioritize and manage multiple tasks. 
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction. 

Education and Experience Requirements:

• High School Diplomaor equivalent 
• One (1) yearwork related experience in health care administrative, financial, or insurancecustomer services, claims, billing, call center or management regardless of industry. 
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience. 
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance. 

Physical Demands and Work Environment:

• Work environment may be stressful at times, as overall office activities and work levels fluctuate. 
• Must be able to bend, stoop, stretch, stand, and sit for extended periods of time. 
• Subject to long periods of sitting and exposure to computer screen. 
• Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use. 
• Must be able to lift 30 pounds as needed. 
• Excellent ability to communicate both verbally and in writing. 
• May be exposed to angry or irate customers or patients. 

Benefits

• Medical
• Dental
• Vision
• Paid Time Off
• 401k

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual's race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law.  This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.