Job
Description
As an RCM Specialist at Nucleon Health, you will play a crucial role in optimizing revenue cycle processes, minimizing receivables, and ensuring accurate billing and claim management. Your responsibilities will include: - Ensuring Medical Coding Compliance: You will be responsible for ensuring adherence to ICD-10 coding standards, reducing AR backlogs, and improving provider documentation. - Managing Claims & AR: Your role will involve handling transparent AR reporting, implementing revenue recovery strategies, and managing denials effectively. - Driving Process Automation: Utilize Electronic Data Interchange (EDI) for electronic claim submission, ensuring efficient transactions through Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) enrolment. - Implementing Denial Management Strategy: Address denials promptly, maintain a high Clean Claim Ratio (CCR), and track and analyze frequent denials to improve processes. - Focusing on Patient Satisfaction: Review patient ledgers, ensure accurate billing, and provide real-time resolution of billing queries to enhance customer satisfaction. - Providing Consultative Support: Collaborate with medical billing specialists to enhance collections, reduce Accounts Receivable (AR) days, and improve Return on Investment (ROI). Qualifications & Skills required for this role include: - A Bachelors degree in Healthcare Administration, Finance, or a related field. - Proven experience in medical billing and revenue cycle management. - Strong understanding of insurance guidelines, Local Coverage Determinations/National Coverage Determinations (LCD/NCD) policies, and coding standards. - Proficiency in Revenue Cycle Management (RCM) software, EDI enrolment, and claim processing automation. - Excellent analytical and problem-solving skills to effectively optimize revenue cycle processes. As an RCM Specialist at Nucleon Health, you will play a crucial role in optimizing revenue cycle processes, minimizing receivables, and ensuring accurate billing and claim management. Your responsibilities will include: - Ensuring Medical Coding Compliance: You will be responsible for ensuring adherence to ICD-10 coding standards, reducing AR backlogs, and improving provider documentation. - Managing Claims & AR: Your role will involve handling transparent AR reporting, implementing revenue recovery strategies, and managing denials effectively. - Driving Process Automation: Utilize Electronic Data Interchange (EDI) for electronic claim submission, ensuring efficient transactions through Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) enrolment. - Implementing Denial Management Strategy: Address denials promptly, maintain a high Clean Claim Ratio (CCR), and track and analyze frequent denials to improve processes. - Focusing on Patient Satisfaction: Review patient ledgers, ensure accurate billing, and provide real-time resolution of billing queries to enhance customer satisfaction. - Providing Consultative Support: Collaborate with medical billing specialists to enhance collections, reduce Accounts Receivable (AR) days, and improve Return on Investment (ROI). Qualifications & Skills required for this role include: - A Bachelors degree in Healthcare Administration, Finance, or a related field. - Proven experience in medical billing and revenue cycle management. - Strong understanding of insurance guidelines, Local Coverage Determinations/National Coverage Determinations (LCD/NCD) policies, and coding standards. - Proficiency in Revenue Cycle Management (RCM) software, EDI enrolment, and claim processing automation. - Excellent analytical and problem-solving skills to effectively optimize revenue cycle processes.
