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CareCentrix · 1 day ago

Revenue Cycle Representative - RCM

United States

Full-time

Remote

Entry Level

$18/hr - $20/hr

2+ years exp

CareCentrix is a healthcare company that focuses on revenue cycle management. As a Revenue Cycle Representative, you will be responsible for claims research, resolving provider payment issues, and ensuring timely reimbursement of receivables.

Health CareHome Health CareWellness

Responsibilities

Ensure the coordination of provider invoice activities leading to timely reimbursement of receivables using available resources including databases, internet, and telephone

Research and resolve denials received that have not passed payer edits and may lead to a final appeal of denied services. Requires knowledge of a variety of system applications both internal and external. Determines and initiates action to resolve rejected invoices, prepares payer corrections, and/or appeals using electronic and paper processes

Provide guidance, assistance, education, and communications with internal and external customers related to insurance and government payers claims processing protocols

Utilize various resources to determine patient’s eligibility, benefits, and health plan confirmation. Including online payer databases, CareCentrix Eligibility platforms, and medical records that may result in provider or payer recoup/rejection activity

Oversee accounts receivable adjustments to resolve overpayments and payment rejections according to standard operating procedures. Analyze and clears payment variances. May prepare adjusted and corrected bills or adjust accounts receivable entries in accordance with existing operating procedures. May include the use of special reporting

Evaluate, analyze and monitor the processing of invoices and on-line notes, utilizing a Windows based data processing system. Monitors payer responses, using Microsoft Excel

Microsoft Access and other software as necessary to ensure prompt payment

Contact providers, physicians, and/or patients to retrieve appropriate medical documentation to substantiate services provided and engage them in assisting CareCentrix in collecting for the payer

Provide payers with detailed itemization of services performed to ensure timely reimbursement

Review EOPs/EOMBs/EOBs for accuracy of patient responsibility

Provide input on accounts receivable process improvements and assisting in their implementation

May assist Lead Collector with training of newly hired associates and re-education of collection teams as necessary

May acts as an information resource for hard to collect accounts and a “grey area” subject expert

Ensure the coordination of special handling or reconciliation of spreadsheets for national payers

Works with internal customers to identify issues which may result in new enhancements or platforms as necessary

Assures the completion and coordination of work in an associate’s absence, or as needed to maintain departmental standards

Participates in special projects and performs other duties as assigned

Qualification

Medical claims processingHealthcare collection proceduresHIPAA knowledgeMicrosoft Office ApplicationsAnalytical skillsMathematical calculationsCPT codingICD-9 codingURAC standardsTime managementCommunication skillsOrganizational skills