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Overview

The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances.

Responsibilities

+ Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.

+ Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.

+ Collaborate with internal teams to address claims challenges and improve revenue cycle.

+ Escalate complex or uncollectible accounts to management for further action.

+ Submit appeals/claim corrections as needed within timely filing limits.

+ Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.

+ Payer projects as assigned.

+ Identify and report trends in claim denials and payment challenges.

+ Communicateasneededwithpatients about billing issues,including theresults ofapplications for financial hardshipassistanceand other responses tocustomerinquiries about

+ Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.

+ Assist in the implementation of processesto measure,assess,and improve the performance of the RCM departmentactivities of thecompany.

+ Ensure ongoingcompliance with alllawsandregulations;ensurethat the department meets orexceedsaccreditation standards; and implement "best practices" in all departmental

+ Participate insurveysconductedby authorized inspection

+ Participate in the company's Performance Improvement program as requested by thePerformance Improvement

+ Participate incompany committees when

+ Participate in in-service education programsprovided by the company.

+ Pursuecontinuing education programs appropriateto job

+ Performotherduties as assigned by

+ Complete all mandatory and regulatory training programs.

+ Reportanymisconduct,suspicious orunethicalactivitiesto the Compliance

+ Complies with accepted professional standards and practice.

Qualifications

Job Skill Requirements:

+ Ability to read and interpret medical records for billing purposes.

+ Competent in mathematic equations.

+ Ability to compute unit conversions for drugs.

+ Understanding of CPT, HCPCS, ICD-10, and NDC codes

+ Diligent attention to detail.

+ Excellent verbal and written communication.

+ Understanding of HIPAA compliance.

+ Self-directed, has the ability to work with little supervision.

+ Proficiency in Excel, Outlook, and all other office applications.

+ Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)

+ Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.

+ Deep understanding of home infusion process, therapies, and related services.

+ Ability to understand payer explanation of benefits.

Educational Requirements:

+ High school diploma or GED

Experience:

+ One to three years of experience in Home Infusion or Specialty Pharmacy collections.

Connect With Us! (https://kphcareers-kphhealthcareservices.icims.com/jobs/13808/revenue-cycle-management-specialist---collections/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336031866)

**Job Locations** _US-OH-Maumee_

**Posted Date** _3 months ago_ _(2/15/2025 3:24 PM)_

**_Requisition ID_** _2025-13808_

**_\# of Openings_** _1_

**_Category_** _Accounting/Finance_

**_Location : Location_** _US-OH-Maumee_