RCM Specialist - Quality

📋 Description

• • Manage and oversee the revenue cycle process for DME/HME services, ensuring timely and accurate billing, claims submission, and payment posting.
• • Conduct thorough accounts receivable (AR) follow-up and denial management, working closely with billing teams to resolve outstanding issues and minimize AR aging.
• • Maintain comprehensive knowledge of US payer policies, rules, and regulations, with specific focus on Medicare, Medicaid, and commercial insurance plans.
• • Collaborate with internal teams including billing, coding, and compliance to ensure accurate and compliant claim submissions.
• • Stay current with industry changes including coding and billing requirements, reimbursement guidelines, and regulatory updates affecting DME/HME revenue cycles.
• • Assist with internal and external audits to ensure adherence to regulatory and contractual obligations.
• • Participate in quality control activities by conducting audits and providing actionable recommendations for process improvements.
• • Apply detailed analytical skills to identify billing discrepancies, root causes of denials, and opportunities for revenue optimization.
• • Communicate effectively with internal stakeholders and external payers to resolve billing issues and clarify policy interpretations.
• • Prioritize tasks and meet deadlines in a fast-paced environment while maintaining high accuracy and compliance standards.
• • Utilize knowledge of DME/HME-specific reimbursement rules to prevent claim rejections and reduce claim turnaround time.
• • Ensure all revenue cycle activities align with company policies and federal/state healthcare regulations.
• • Support continuous improvement initiatives by documenting best practices and contributing to training materials for billing and coding teams.
• • Maintain up-to-date awareness of evolving healthcare reimbursement landscapes and adapt processes accordingly.
• • Work independently and as part of a team to achieve departmental and organizational revenue cycle goals.