Revenue Cycle Management Specialist chez Pain Treatment Centers of America

Description

SUMMARY OF RESPONSIBILITIES 

The RCM Specialist at AAIT Health is responsible for supporting all aspects of the revenue cycle, including billing, collections, claims management, and patient account resolution. This position ensures accuracy and compliance in processing medical claims, works closely with insurance carriers, and provides guidance to clinic staff on revenue cycle processes to maximize reimbursements and reduce denials.

ESSENTIAL FUNCTIONS

· Perform accurate and timely charge entry, claim submission, and payment posting.

· Manage insurance eligibility verification, authorizations, and patient cost estimates.

· Review and resolve claim rejections, denials, and underpayments.

· Handle patient billing inquiries and provide professional support regarding account balances, statements, and payment plans.

· Maintain compliance with payer guidelines, state and federal regulations, and company policies.

· Monitor and reconcile accounts receivable, identify trends, and escalate unresolved issues to management.

· Generate and analyze reports on collections, denial rates, and reimbursement patterns.

· Collaborate with internal departments and external vendors to resolve complex billing issues.

· Support continuous process improvement initiatives to streamline revenue cycle operations.

· Participate in training, cross-coverage, and departmental meetings to enhance performance and knowledge.

Requirements

CORE COMPETENCIES

· Strong knowledge of medical billing, insurance claims, and reimbursement methodologies.

· Excellent oral and written communication skills.

· High attention to detail with the ability to identify and resolve discrepancies.

· Ability to work independently, manage multiple tasks, and meet deadlines.

· Strong problem-solving and analytical skills.

· Professionalism, integrity, and dependability in all work-related activities.

REQUIRED EDUCATION, EXPERIENCE, AND/OR CERTIFICATIONS

· High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, business, or related field preferred.

· Minimum of 3 years of experience in medical billing, collections, or revenue cycle operations within the healthcare industry.

· Knowledge of CPT, ICD-10, and HCPCS coding strongly preferred.

· Familiarity with electronic health record (EHR) and practice management systems.

· Certification such as Certified Revenue Cycle Specialist (CRCS) or Certified Professional Coder (CPC) preferred but not required.

WORKING ENVIRONMENT AND PHYSICAL DEMANDS

This is a full-time position. Standard hours are 7:00 a.m. to 5:00 p.m., Monday through Thursday. Overtime may occasionally be required. The position operates in a professional office or remote environment and involves sitting, typing, using standard office equipment, speaking, listening, and frequent communication via phone and email.

OTHER

Performance is evaluated by the Revenue Cycle Manager or Director of Operations. AAIT Health reserves the right to modify this job description at any time according to business needs. This document does not constitute a contract of employment, and employment with AAIT Health is at-will.