RCM Analyst

Description

Since 1958, The Ear, Nose, Throat & Plastic Surgery Associates has combined quality patient care with state-of-the-art innovation. With a tradition of excellence more than 50 years strong, our unanimous goal is to serve our patient’s individual needs and exceed their expectations. We are uncompromisingly dedicated to excellence and achieving quality results for every patient that chooses to visit us.

The RCM Analyst will be responsible for communicating with patients and insurance carriers to support claim integrity, root cause analysis, accuracy, and resolution on all patient accounts. The analyst will be responsible for inbound/outbound calls to resolve patient billing questions and collection of payments. The analyst may be responsible for charge entry, charge approval, payment posting, overpayments/credits & refunds, clearinghouse and payer rejections, custom claim edits, and/or accounts receivable follow up on claims that are denied, underpaid, or no payment activity/payer response to result in payment/resolution on the patient account. The representative will review accounts to identify issue and take appropriate action following up with patient or insurance on the aged, delayed, overpaid, underpaid, or denied claims, and the representative will note accounts appropriately and upload supporting attachment/documents per the quality assurance standard of what, when, where, why, and how to support actions taken/work performed.

RCM Analyst Working Schedule

Monday - Friday, 8:00 am - 5:00 pm

This position is eligible to be a fully remote position.

Major Duties And Responsibilities

• Actively and consistently support patient account resolution to simplify and enhance the patient’s experience.
• Ability to complete a gap analysis and identify root causes of issues/errors in all workflows suggesting process improvement to gain efficiencies and create a culture of quality.
• Ability to research and accurately utilize technology – payer portals, lockbox, clearinghouse, practice management & EHR billing system, Microsoft, Email, Teams, Word, Excel, PowerPoint.
• Establish and maintain a high level of customer satisfaction, professionalism, and courtesy during all transactions.
• Consistently meet or exceed weekly and monthly performance metrics of production, quality, and attendance and department key performance indicators (KPI) set for role.
• Daily reconciliation and reporting required to include production/performance self-reporting.
• Responsible for accurate and timely data entry of charges, payments, adjustments, edits, denials, underpayments, overpayments, or no payer response claims, etc.
• Ability to learn and master billing system regarding all aspects of data entry, billing inquiries, and other tools and functions.
• Have a full understanding of and consistently demonstrate proficiency at explaining all services to insurance carriers and patients.
• Other duties as assigned based upon role, inventory, and changing business needs.
• Collaborate and partner with team and other departments to resolve patient and/or insurance issues.
• Follow ENTPSA policies & procedures, including but not limited to letter generation, collection phone calls and standard appeal template documentation.
• Responsible for peer training and quality assurance, when needed.
• Follow corporate collection policies & procedures, including but not limited to, letter generation, collection phone calls and required collection documentation.
  
  

Workflows Include, But Not Limited, To The Following

Patient Account Billing Line

Charge Management - Charge Entry & Charge Approval

Payment Posting

Overpayment & Non-Contractual Adjustments

Accounts Receivable Follow Up & Claim Management

Training & Quality Assessment

System Configuration & Maintenance

• Ability to understand claim form logic/claim edits and configure system as appropriate.
• Ability to update charge master and/or payer fee schedules as appropriate.
  
  

Requirements

• Ability to read, write, speak, and understand English. Spanish is a plus.
• Ability to work in a remote environment with little supervision.
• Ability to apply appropriate collection techniques and demonstrate sustained achievement of stated goals.
• Ability to use personal computer and appropriate software applications to include billing system and other role-related tools.
• Effective verbal and written communication skill
• Effective organizational skills
• Ability to prioritize and organize effectively.
• Ability to show judgment and initiative to accomplish job duties.
• Ability to perform job at workstation for prolonged periods of time.
• Must be computer savvy using applications Microsoft Office, Windows PC, Excel, practice management systems, etc.
• Ability to effectively present information and respond to questions from patients and insurance carriers in a clear, straight forward, and professional manner.
• Ability to calculate figures and amounts such as discounts, proportions, percentages, and volume.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
  
  

EDUCATION/CERTIFICATIONS

• High School Diploma required; college degree or college credits preferred. RCM or medical billing certification or coding certification such as CPC or CCS-P.
  
  

PREFERRED QUALIFICATIONS: Combination of related Work Experience, Number of Years, and Education

• 2 years or less – RCM Analyst I
• 3-5 years – RCM Analyst II
• 6 years – RCM Analyst III
  
  

NOTE: This job description is not intended to be all-inclusive. Other duties as assigned to meet business needs.