RCM Team Lead

Job Summary

Responsible to know and facilitate specific accounts and their unique attributes in order to successfully provide

customized RCM for each account. This is a dual position with its own workload along with oversight to train,

audit and monitor the group for accurate procedures and turnaround. Ensure workflow, including collecting

payments stays current and on track with regards to insurance carriers, patients, clients and internal

interactions. Supports the overall

Operations and Client Services by efficiently and effectively providing and reviewing account data needed for the

Revenue Cycle process and delivering results.

Essential Functions/Major Job Responsibilities

• Strong customer service skills for client satisfaction, health of client AR and guidance for RCM team
  
  

members

• Answers client calls; prompt return and follow up to all interactions; prompt response to requests for
  
  

information, both internally and externally.

• Acts as initial point person for team regarding technical work questions/processes/procedures to provide
  
  

training/guidance.

• Escalates issues to RCM Management related to clients and staff.
• Trains individuals on systems and workflow in order to ensure protocols are followed.
• Reviews and works all unpaid and denied insurance correspondence, both phone appeals and written
  
  

appeals; confirm all patient demographics and insurance is current and up to date.

• Runs, reviews and works unpaid patient balance reports for payment by reading current notes and place for
  
  

past due letters and phone calls.

• Prepares insurance/patient correspondence for coworkers by reviewing and batching for further attention
  
  

and review.

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• Prepares and sends uncollected patient payments to collections by writing up forms for the doctors to
  
  

review.

• Reviews and works insurance and patient over payments, prepare refund request and send to doctor's
  
  

office.

• Answers phone calls from insurances and patients.
• Organizes, identifies and improves workflow with team members/Management through daily and weekly
  
  

productivity reports and reports challenges and concerns and requests need for assistance to RCM

Management.

• Ability to perform the duties of the Payment Entry Specialist, Charge Entry Specialist, AR Specialist and
  
  

RCM Specialist roles.

• Keeps manager informed of progress, achievements and issues; assist staff with processes, information
  
  

and workload.

• Achieve goals set by management and compliance requirements.
• Follows, and models adherence to all policies, procedures and processes.
• Other duties as assigned.
  
  

Knowledge, Skills And Abilities

• Knowledgeable of CPT and ICD coding and medical terminology
• Extensive knowledge with email, search engines, Internet, ability to effectively use payer websites and
  
  

Laserfiche; basic competence in use of Microsoft products.

• Preferred experience with MS Access and PowerPoint, Crystal reports and various billing systems, such
  
  

as NextGen, Pro, Allscripts, Epic and others

• Knowledge of CPT, ICD10 and modifiers.
• Experience in specialities such as Psychiatry, Internal Medicine, Orthopaedics, General Surgery
• Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers
• Strong communication skills
  
  

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
• Peer-based incentive Cheer awards
• 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/

Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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