REP RCM ACCOUNTS RECEIVABLE III

Accountabilities:: As a REP RCM Accounts Receivable III, you will oversee intermediate-level accounts receivable follow-up and collection activities, ensuring claims are processed accurately, outstanding balances are addressed promptly, and departmental performance standards are consistently achieved. Follow up on outstanding healthcare claims and appeals to support timely reimbursement. Review escalation queues, vendor clarification logs, correspondence, and assigned account reports to identify and resolve outstanding issues. Investigate claim acknowledgment rejections, billing edits, charge corrections, and other claim processing discrepancies. Research and audit patient accounts to determine appropriate payments, adjustments, and corrective actions. Contact patients regarding outstanding balances and arrange payment plans when necessary. Respond to incoming calls from patients, insurance companies, and physician offices, providing accurate information and professional support. Print and resubmit claims as needed, manage daily correspondence, and address claim transmission issues. Work assigned key account management reports and accounts receivable collection queues, demonstrating proficiency within the first 30–60 days of employment. Process approximately 40–50 accounts daily while maintaining an accuracy rate of at least 90% and meeting applicable productivity standards. Calculate billing units and reimbursement amounts accurately. Provide training to employees and vendors and act as a knowledge resource for team members. Maintain ongoing professional development and complete required industry training. Protect confidential patient and business information and comply with applicable policies, procedures, and ethical standards. Report suspected compliance violations, harassment, or other prohibited activities through established reporting channels and seek clarification when needed. Contribute to a culture of excellence, collaboration, integrity, accountability, and continuous improvement. Perform additional duties as assigned. Requirements: The ideal candidate has solid healthcare revenue cycle experience, a strong understanding of insurance reimbursement and claims processing, and the analytical and communication skills needed to resolve complex accounts independently. High school diploma or equivalent required. Three to five years of experience in a healthcare insurance receivables environment. Two to three years of collection experience required. Experience in healthcare billing, payment posting, medical coding, or accounts receivable collections is preferred, particularly within a healthcare organization. Associate or bachelor’s degree in Business Administration or a related field preferred. Working knowledge of CPT, ICD-9, and ASA coding systems. Understanding of medical terminology, insurance processing requirements, and applicable healthcare regulations. Advanced understanding of commercial insurance, Medicare, and Medicaid payer requirements and reimbursement guidelines. Familiarity with TWCC guidelines and laws, commercial managed care insurance, and relevant claims procedures. Ability to evaluate and correct billing edits, manage claim transmissions and rejections, and perform other essential billing functions accurately. Strong mathematical, research, analytical, decision-making, and problem-solving skills. Ability to gather, analyze, and report data effectively. Strong verbal and written communication skills and the ability to work professionally with physicians, external customers, hospital staff, colleagues, and senior leadership. Team-oriented approach, positive attitude, and ability to collaborate with people from diverse backgrounds. Ability to work independently with limited supervision while managing competing priorities. Proficiency with Microsoft Office, particularly Word and Excel, and general PC applications. Commitment to confidentiality, ethical conduct, compliance, accuracy, and continuous professional development. Ability to meet the role’s productivity and quality standards in a remote working environment. Benefits: Remote work opportunity. Medical, dental, and vision insurance options. Life insurance and disability coverage. Paid time off, with the opportunity to accrue 20–25 days per calendar year depending on position and applicable terms. Nine observed paid holidays. Paid family leave. 401(k) retirement plan with company matching. Healthcare Flexible Spending Account (FSA) options. Dependent Care FSA and Limited Healthcare FSA options. Transportation and parking FSAs. Health Savings Account (HSA) options. Training, professional development, and career growth opportunities. Employee recognition and a collaborative workplace culture. Commitment to equal employment opportunities and reasonable accommodations for qualified candidates with disabilities.