Revenue Cycle Management (RCM) Specialist in Brevard, North Carolina at Hendersonville Pediatrics Pa

Job Description
• Reports to: Billing Supervisor
• Direct Reports: None
• Job Type: Full-time
• FLSA Classification: Non-Exempt
• Travel Requirement: Minimal; occasional travel between office locations as needed
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Position Summary
The Revenue Cycle Management (RCM) Specialist optimizes the practice's financial performance by managing the full lifecycle of patient accounts, ensuring accurate billing, coding compliance, and timely claims resolution. This role serves as a critical link between clinical documentation and reimbursement while providing operational support to clerical teams at all office locations.________________________________________
Benefits
• 401(k) with company match
• Medical, dental, and vision insurance
• Paid time off (PTO)
• Life insurance
• Short- and long-term disability insurance
• Employee discount on services
• Employee Assistance Program (EAP)
• Uniform allowance
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Key Responsibilities
Claims & Revenue Cycle Operations
• Claims Processing: Key and transmit insurance charges for both office locations, including specialized entries for behavioral health specialists.
• Denial Management: Identify, correct, and adjust claims for all denials and monitor the aging report to minimize lost revenue.
• Payment Posting: Accurately post payments from all insurance providers and process payments received via phone or mail.
• Revenue Monitoring: Track accounts receivable (A/R) and expedite the recovery of outstanding payments to enhance cash flow.
• Medicaid Coordination: Liaise directly with all insurance carriers and provide necessary NPI/authorizations to external providers.
Patient Accounts & Financial Services
• Collections Management: Coordinate with collection agencies (e.g., Fairway Recovery Services) to manage delinquent accounts, send required collection letters, and set up patient payment plans.
• Patient Advocacy: Respond to billing and insurance inquiries and provide parents with itemized financial reports for tax or insurance purposes.
• Refunds & Adjustments: Audit patient accounts for overpayments and process refunds as necessary.
• Financial Reporting: Prepare end-of-month closing reports and regular metrics on billing activities and revenue performance.
Compliance & Practice Support
• Coding Compliance: Stay current on ICD-10, CPT, and HCPCS coding changes through ongoing education and professional seminars.
• Insurance Verification: Verify patient coverage and benefits to ensure eligibility prior to service.
• Clinical Liaison: Coordinate with physicians to ensure clinical documentation meets the requirements of standard billing procedures.
• Data Maintenance: Update patient records based on Post Office returns and ensure insurance card data entry is accurate for both offices.
Operational Synergy
• Staff Support: Provide backup coverage for the front desk at both Hendersonville and Brevard locations as needed.
• Training: Facilitate the training of new clerical employees on insurance card data entry and general front-desk duties.
• Internal Audits: Conduct morning audits of patient charts to identify and address past-due balances before appointments.
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Qualifications
• Education: Bachelor’s degree in Healthcare Administration, Finance, or a related field preferred.
• Experience: Minimum of 2 years of experience in medical billing and coding preferred.
• Certification: Professional certification (e.g., CPC or CCS) is highly desirable.
• Technical Skills: Proficiency with Electronic Health Records (EHR) and healthcare billing software.
• Core Competencies: Strong knowledge of healthcare regulations (HIPAA), data analysis skills, and high attention to detail.
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Schedule
• Full-time
• Monday–Friday, 8:00 am–5:00 pm (average 40 hours per week)
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Other Duties
This job description is not intended to be an exhaustive list of duties, responsibilities, or activities. Additional tasks may be assigned as needed to support the practice's goals and objectives.
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Equal Opportunity Employer
Hendersonville Pediatrics provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.