RCM 计费专员（兼职）
RCM Billing Specialist (Part Time)
InfuSystem 是一家快速发展的医疗保健服务提供商，专注于输注泵及相关产品和服务，为医院、诊所、日间手术中心和其他主要服务中心的患者提供服务。我们提供直接付费方租赁、泵和消耗品销售以及生物医学服务和维修，覆盖美国全部50个州和加拿大。公司总部位于密歇根州罗切斯特山，在堪萨斯州、加利福尼亚州、马萨诸塞州、德克萨斯州和加拿大的安大略省设有卓越中心。
作为本领域的领导者，我们的使命是为患者和医疗机构提供高质量的输注服务，包括24小时临床支持热线。团队合作为产品管理和临床支持提供保障，以提升患者及我们服务社区的生活质量。服务始终是我们最高的优先事项；将患者的健康与安全置于我们所做一切的核心位置。
摘要：
收入周期计费专员负责与第三方付费方计费相关的活动管理。这包括，受益人验证、获取授权以及及时准确地提交索赔。确保所有已计费的索赔符合所有联邦和州的要求，并满足付费方的要求。该职位应具有DME及其他医疗相关服务的计费工作经验。
在该职位中，理想的候选人应具备以下能力：
- 能够解读付费方的费用说明（EOBs），以确保索赔的正确报销，并向管理层报告任何问题、异常或付费方趋势
- 与付费方和/或付费方网络门户合作，确定前端拒付的原因，并及时更正并重新提交索赔以获得报销
- 根据需要通过各种工具进行保险重新验证，并相应地向新付费方发起计费或重新处理索赔，或向患者计费
- 及时处理第三方付费方的信件、退款和调整
- 及时了解付费方的信息通知和变更
- 与团队分享改进流程的信息和想法
- 及时回应所有患者咨询
- 遵守所有工作指令、政策和行为期望
工作质量和数量
团队成员需达到定期的生产目标，并保持高水平的质量。将定期进行质量审计，并为团队成员提供反馈和教育，以支持其成长和发展。
监督
查看英文原文
InfuSystem is a growing healthcare service provider, specializing in infusion pumps and related products and services for patients in hospitals, clinics, ambulatory surgery centers, and other major service centers. We provide direct payer rentals, pump and consumable sales, and biomedical services and repair, serving all 50 states and Canada. Headquartered in Rochester Hills, Michigan, we have Centers of Excellence in Kansas, California, Massachusetts, Texas and Ontario, Canada.
As a leader in our field, our mission is to provide quality infusion services to patients and medical practices, including a 24‐hour clinical support hotline. Our team effort provides product management and clinical support to enhance the lives of our patients and the communities we serve. Service is always our highest priority; keeping the patients’ health & safety at the center of everything we do.
SUMMARY:
The Revenue Cycle Billing Specialist is responsible for the management of activities relative to third party payer billing. This includes, benefit verification, obtaining authorizations and timely and accurate filing of claim submission. Ensuring that all claims billed are following all federal and state requirements and meeting the requirements of payers. This position should have billing work experience in DME and other healthcare related services.
IN THIS ROLE, THE IDEAL CANDIDATE WILL:
- Have capability to interpret payer explanation of benefits (EOBs) to ensure proper reimbursement of claims and report any problems, issues, or payer trends to management
- Work with payers and/or payer web portals to determine reasons for front end denials and correct and resubmit claims for reimbursement in a timely manner
- Conduct insurance reverification as needed through various tools and initiate billings to a new payer or reprocess the claim accordingly or bill patient
- Process third party payer correspondence, refunds, and adjustments timely
- Remain up to date on payer informational notices and changes
- Share information and ideas for process improvements with team
- Respond to all patient inquiries timely
- Comply with all work instructions, policies and behavioral expectations
QUALITY AND QUANTITY OF WORK
Team members will be responsible for hitting regular productivity targets with a high level of quality. Quality audits will be performed on a regular basis and feedback and education will be provided to the team member to help support growth and development.
SUPERVISORY RESPONSIBILITIES:
This position has no supervisory responsibilities
THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:
- Associate Degree or equivalent preferred; minimum two years related experience; or equivalent combination of education and experience
- Preferred experience related to Negative Pressure Wound Therapy
- Organizational skills
- Good troubleshooting skills
- Strong attention to detail
- Proficient with Word, Excel, Outlook
- Operate Express/HDMS/WayStar proficiently
- Understanding of insurance guidelines including Medicare, Medicaid, Workers Compensation and all Commercial managed-care plans
- Ability to handle inquiries and respond via telephone or in writing
- Ability to explain and resolve collections related questions/issues to patients, sales representatives and facilities
- Proper use of ICD-10, CPT and HCPCS codes
- Ability to independently meet tight deadlines in a project-based atmosphere
PERSONAL AND PROFESSIONAL ATTRIBUTES:
The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:
- Strong work ethic
- Sound judgment
- Proven written and verbal communication skills
- Natural curiosity to pursue issues and increase expertise
- Pursue and design innovative analytical performance metrics
- The courage to promote and defend ideas and analyses
- Passionate about InfuSystem and serving customers and patients
- Strives to make an impact on improving our business processes and results
- Exemplary honesty and integrity
- Ability to collaborate effectively and work selflessly as part of a team
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Originally posted on Himalayas