RCM AR Specialist

Veradigm

Veradigm is here to transform health, insightfully. Veradigm delivers a unique combination of point-of-care clinical and financial solutions, a commitment to open interoperability, a large and diverse healthcare provider footprint, along with industry proven expert insights. We are dedicated to simplifying the complicated healthcare system with next-generation technology and solutions, transforming healthcare from the point-of-patient care to everyday life.

For more information, please explore Veradigm.com.

What will your job look like:

JOB SUMMARY

Responsible for the overall recovery and management of accounts receivable as it relates to maximizing accounts receivable collections for RCMS clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of
appeals and responses to efficiently interact with insurance carriers and resolve the claim. Supports the RCMS BU's overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and achieving KPI results.

No budget responsibilities, but must meet established RCM KPI's.

ESSENTIAL FUNCTIONS/MAJOR JOB RESPONSIBILITIES

• Strong customer service skills for client satisfaction and client AR health
  answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for information
• Timely management of unpaid claims as assigned, through the use of the client's office management/administrator;
  aging reports; correspondence; Clearinghouse and PM rejections; SharePoint reference/maintenance
• Effectively handle complex payer denials; responsible to ensure that secondary claims are processed and paid
• Monitoring and reconciliation of claims to include:
  Held vouchers
  
  • Unbilled vouchers
  • Denial trends
  • Patient balance report
  • Credits and refunds
• Manage and track information requests to client.
• Answer and resolve all incoming calls and requests in a timely manner.
• Complies with and enforces policies and procedures
• Achieves goals set forth by RCM management regarding error-free work, transactions, processes, productivity and compliance requirements. Specific goals include 1,400 accounts worked per month
• May act as partner for new hires to assist them in learning
• Other duties as assigned

An Ideal Candidate will have:

Education

• Bachelor's degree or equivalent preferred.

Work Experience

• 2-3 years of relevant work experience in RCM AR preferred.

Working Arrangements

• Remote, India.

Knowledge, Skills, and Abilities

• Extensive knowledge with email, search engines, Internet
• ability to effectively use payer website and Laserfiche; basic competence in use of Microsoft products
• Preferred experience with MS Access and PowerPoint, Crystal reports
• Experience with various billing systems, such as NextGen, Pro, Allscripts, Epic and others
• Knowledge of CPT, ICD10 and modifiers.
• Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
• Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish.

• Quarterly Company-Wide Recharge Days
• Flexible Work Environment (Remote/Hybrid Options)
• Peer-based incentive "Cheer" awards
• "All in to Win" bonus Program
• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/

https://veradigm.com/about-veradigm/careers/culture/

We are an Equal Opportunity Employer. No job applicant or employee shall receive less favorable treatment or be disadvantaged because of their gender, marital or family status, color, race, ethnic origin, religion, disability or age; nor be subject to less favorable treatment or be disadvantaged on any other basis prohibited by applicable law.