RCMS Associate I Vadodara, India

4 weeks ago


Vadodara, India Qualifacts Systems Inc Full time

Description

Job Title: Revenue Cycle Management (RCM) Billing Specialist

Overview:

As a Billing Specialist within our Revenue Cycle Management (RCM) team, you will play a critical role in ensuring accurate and timely submission of insurance claims. Your primary responsibilities will include verifying claim completeness and accuracy, meeting charge generation deadlines, interpreting insurance explanation of benefits (EOBs), attending educational sessions, and adhering to HIPAA guidelines. Your attention to detail and commitment to zero errors will contribute to improving our clean claim ratio and optimizing revenue cycle processes.

Key Responsibilities:

1. Ensure Zero Errors in Claims Submission:

- Verify the completeness and accuracy of all insurance claims prior to submission, aiming for zero errors to improve clean claim ratio.

2. Meet Charge Generation Deadlines:

- Ensure timely generation of charges and meet deadlines for claim submission to insurance companies.

3. Interpretation of Explanation of Benefits (EOBs):

- Read and interpret insurance EOBs to reconcile payments, denials, and adjustments for claims processing.

4. Attendance at Monthly Meetings and Educational Sessions:

- Regularly attend monthly staff meetings and participate in continuing educational sessions as requested to stay updated on industry trends and best practices.

5. Additional Duties as Requested:

- Perform additional duties as requested by the supervisory or management team to support departmental objectives.

6. Data Entry for Insurance Claims:

- Enter patient, insurance ID, diagnosis and treatment codes, modifiers, and provider information into the billing system, ensuring completeness and accuracy of claim information.

7. HIPAA Compliance:

- Follow HIPAA guidelines and maintain confidentiality when handling patient information during claims processing.

8. Submission of Insurance Claims:

- Submit insurance claims electronically or via paper CMS-1500, UB04, and/or other forms to clearinghouses or individual insurance companies.

- Utilize knowledge of insurance portals and clearinghouses to facilitate claims submission efficiently.

9. Understanding of Medical Billing Cycle:

- Possess a brief understanding of the entire medical billing cycle, including claim submission, payment posting, and denial management.

10. Continuous Improvement:

- Strive for continuous improvement in claims submission processes to minimize errors and optimize revenue cycle efficiency.

Qualifications:

- High school diploma or equivalent; associate or bachelor’s degree in healthcare administration, Commerce or related field preferred.

- Minimum of 1-2 years of experience in medical billing or revenue cycle management, with a focus on claims submission.

- Strong attention to detail and accuracy in data entry and claims verification.

- Knowledge of CPT, ICD-10, and HCPCS coding principles.

- Familiarity with insurance EOBs and claim reconciliation processes.

- Proficiency in using billing software and electronic health record (EHR) systems.

- Understanding of HIPAA regulations and patient privacy requirements.

- Excellent communication and interpersonal skills.

- Ability to work independently and collaboratively in a fast-paced environment.

- Commitment to meeting deadlines and achieving departmental goals.



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