Job Summary:
As an RCM Specialist at Nucleon Health, you will be responsible for optimizing revenue cycle processes, minimizing receivables, and ensuring accurate billing and claim management. Your role will involve eligibility verification, denial management, medical coding, and automation of billing processes to maximize revenue and enhance customer satisfaction.
Key Responsibilities:
- Revenue Maximization: Ensure timely payment by resolving eligibility, LCD/NCD, insurance guidelines, and DX/CPT code issues.
- Eligibility Verification: Conduct pre-appointment verification to aid co-pay collection and reduce denials.
- Medical Coding Compliance: Ensure ICD-10 adherence, reduce AR backlogs, and improve provider documentation.
- Claims & AR Management: Handle transparent AR reporting, revenue recovery, and denial management strategies.
- Process Automation: Utilize EDI for electronic claim submission, ensuring EFT and ERA enrolment for efficient transactions.
- Denial Management Strategy: Address denials promptly, maintain a high Clean Claim Ratio (CCR), and track frequent denials.
- Patient Satisfaction: Review patient ledgers, ensure accurate billing, and provide real-time resolution of billing queries.
- Consultative Support: Collaborate with medical billing specialists to improve collections, reduce AR days, and enhance ROI.
Qualifications & Skills:
- Bachelor's degree in Healthcare Administration, Finance, or related field.
- Proven experience in medical billing and revenue cycle management.
- Strong understanding of insurance guidelines, LCD/NCD policies, and coding standards.
- Proficiency in RCM software, EDI enrolment, and claim processing automation.
- Excellent analytical and problem-solving skills.
