Specialist, RCM

This Specialist will join the remittance posting teamand be responsible for processing insurance company takeback requests refunds zero-pay remittances and other tasks related to payment and remittance posting. The Revenue Cycle Management (RCM) team is looking forsomeone with insurance claims and/or remittance posting experience plus critical thinking skills attention to detail and the ability to learn quickly and adapt to a changing environment.

Education/Experience:

• High School Diploma required
• Two years experience in healthcare administration/revenue cycle
• CRCR Certification preferred

Skills:

• Demonstrates excellent customer service
• Ability to convey empathy
• Strong problem-solving problem-prevention and decision-making skills
• Ability to manage and prioritize multiple tasks in a fast-paced environment
• Excellent oral and written communication skills
• Ability to maintain composure and restore calm in a stressful situation
• Uses good judgment and diplomacy when dealing with others
• Desire and ability to work in a team environment
• Computer proficient with the ability to learn multiple software applications
• Ability to work with minimal supervision

Primary Responsibilities:The purpose of this position is to execute follow-up actions on insurance claims; expedite positive cash flow maximize reimbursement and resolve claims denials and issues with payers in the assigned area of the Revenue Cycle claims process.

Essential Functions:

• Help develop &maintain a corporate culture that supports the mission and values of Mayfield Clinic
• Follow up on submitted electronic & hard copy claims in an accurate timely manner; submit appeals make corrections to overturn denials post payments & process takeback requests as required.
• Make all necessary corrections to claims that do not pass billing edits/payer requirements & resubmit to payers.
• Contact payers regarding unpaid claims. Research and/or ensure that questions and requests for information are addressed in a timely & professional manner to ensure resolution & reimbursement.
• Ensure timely & accurate posting of remittance advice information & follow up as needed to ensure full expected reimbursement for services provided.
• Maintain documentation and update our practice management system for appropriate claims submission & other pertinent information to identify action taken.
• Make necessary adjustments as appropriately required by plan reimbursement & company policy.
• Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
• Research & initiate requests for refunds for accounts with credit balances.
• Answer & initiate phone inquiries regarding bills charges claims and account status.
• Update data in the practice management system as required.
• Contribute to the team environment by performing other duties as assigned.

Physical Requirements:

• Hand Movement including repetitive motions grasping holding and finger dexterity. Reading Writingand Hand-Eye Coordination. Vision including color distinction and visual inspection. Hearing talking sitting lifting up to 10 pounds bending reaching

Mayfield Clinic Mission: To provide the best neurological care for our patients through:

• Superior clinical outcomes
• Compassionate patient care
• Education and research
• Innovation

Mayfield Clinic Values:All associates who are affiliated with the Mayfield Clinic must agree to use these values as a basis fortheir employment and recognize that they are part of the associates annual Performance Review andDevelopment Plan:

• Integrity:We commit to honest and ethical behavior in all of our endeavors and interactions.
• Excellence: We commit to the highest level of performance and continuous improvement.
• Respect: We embrace the importance of all individuals & value their diverse backgrounds skills & contributions.
• Compassion:We commit to being compassionate and empathetic in all of our interactions.
• Collaboration: We embrace teamwork mentoring cooperation sharing of expertise & empowerment.