Revenue Cycle Management Specialist na NationsBenefits, LLC

NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members.

Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.

Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members.

We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.

Role:

The Revenue Cycle Representative is a dedicated, driven professional who takes initiative and can multi-task to fulfill all functions of the revenue cycle including processing of claims, following up on aging revenue, payment posting and collections for various clients.

Responsibilities:

• Review all billing guidelines, benefits verifications, and coding, as required, based on the designated client.
• Claim Billing and collection for multiple clients and multiple locations.  
• Follow up with insurance on pending payments via phone, web portal and/or fax and expedite claim processing to maximize reimbursement and avoid bad debt.
• Review patient demographic, insurance carrier information and reconciliate payments to maintain a clean AR.

• Understanding of eligibility benefits and claims processing to identify discrepancies for claim resolution.
• Review EOB’s/contracts and fee schedules to ensure maximum cash collections.
• Process payments from insurance companies, prepare daily deposits and apply manual payments/adjustments/write offs based on Explanation of Benefits in a timely manner.
• Gather trends relevant to AR scenarios to report to management progression of collection and AR monitoring.
• Perform denial management functions by resolving incoming denials through appeals or reprocessing of claims.
• Respond to customer and insurance inquiries via mail, email, fax or phone call in a timely manner.
• Communicate with and assist patients with billing questions, inquiries and collecting payments.
• Provide feedback and suggestions on workflow improvement, trends, and areas of opportunity.
• Review fee schedules to ensure proper payment (as required by client) and submit appeals as needed.
• Knowledgeable in multiple processes of the RCM Department and able to provide coverage for any team including but not limited to:  follow up, cash receipts, customer service, denial management and/or special projects.
• Maintain strict confidentiality; adheres to all HIPAA guidelines/regulations.

Requirements:

• High School Diploma or GED
• 2 years experience in healthcare field or in a similar role
• Experience with Insurance Provider Portals
• Knowledge of medical billing preferred

NationsBenefits is an equal opportunity employer.