Revenue Cycle Management (RCM) Specialist
Second Nature Counseling is an expanding group mental health counseling practice, located in Downtown Schenectady, NY. Our team currently consists of 5 mental health counselors and support staff. Our team has grown by 500% in the last year and we continue to add clinicians as the need for mental health counseling grows in the Capital Region. We are currently offering tele-health services to our clients, during the COVID-19 pandemic, and will be returning to in-person services by the beginning of 2021. Second Nature Counseling’s mission is to provide client-driven, accessible mental health counseling services to the Capital Region community, while maintaining a culture of innovation, teamwork, and support for our team members.
CommonSense Mental Health is a growing group of social workers and mental health counselors (currently 15 of us) located in the Capital Region of Upstate New York, with satellite providers as far west as Rochester and serving clients all over the state. We specialize in tele-mental health, including videoconference, phone, and text-based services. Our mission is two-fold: improve access and reach to clients through tele-mental health services while ensuring our providers and administrative staff are paid fairly, at or above market-based rates. We also offer clients (local to the Capital Region) in-person services when it is safe to do so (these services have been on pause due to the pandemic).
Collectively, the two groups are seeking candidates for a Revenue Cycle Management (RCM) Specialist who will provide support to both clients and providers, specifically through the responsibilities listed below.
Under general supervision by the Executive Director and CEO of each group, the Revenue Cycle Management (RCM) Specialist is responsible for providing all billing and collections daily as well as reporting metrics to support daily, monthly, quarterly and yearly revenue and collections goals; timely reviewing of codes for accuracy; accurate timely creation and submission of claims to medical insurance companies; timely resubmission and/or appealing denied claims; posting payments and adjustments; answering complex patient billing inquiries and accurate timely reviewing and working aging accounts. Performs other billing related duties to assist in revenue cycle management.
In addition, the RCM Specialist shall have extensive credentialing experience and is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by all commercial payers, Medicare, and Medicaid. Attention to detail, exceptional leadership skills and strong analytical ability is a must.
Essential Duties & Responsibilities
- Billing & Insurance
- Current Certified Coding Credentials, preferred
- Enter and/or confirm medical codes and diagnosis code(s)
- Process insurance claims; tracking and documenting claims processing trends; adjusting submision process, as necessary
- Submit claims via EDI, paper, etc.
- Ensure claims were received by insurance companies
- Review EDI reports to ensure claims were sent; correct and resend, as needed
- Follow up on denied claims and appeals
- Work Aging Report, conducting timely reviews of all aging accounts, until account balance is cleared
- Responsible for receiving EOBs; posting payments, adjustments & sending appeals Issue monthly statements
- Perform patient account reconciliation: post payments; post adjustment
- Respond to complex patient billing inquiries
- Review Aged Debit/Credit Report
- Contact clients regarding statement balances due
- Send demand and collection letters
- Send accounts to collections and or attorney
- Process payments and refunds via phone
- Responsible for maintaining updated claims submission information that is issued by insurance carriers to bill accurately and timely.
- Communicate any insurance processing guideline(s) changes/new implementations
- Provide billing metrics reporting claims aging analyses per insurance; code specific reimbursement updates/changes and research trends to provide analyses as needed
Credentialing & Provider Maintenance
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
- Maintain internal provider grid to ensure all information is accurate and logins are available
- Update each provider’s CAQH database file as needed and assist in re-attestations when required
- Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
- Complete re-validation requests issued by government payers
- Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
- Complete re-credentialing applications for commercial payers
- Work closely with the Executive Director and CEO to identify and resolve any denials or authorization issues related to provider credentialing
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
- Bachelor’s degree preferred; associate degree required
- 5-7 years of experience in the medical field in physician or behavioral health offices as well as medical billing and collection knowledge
- Experience with TherapyNotes and/or Valant EHR preferred
- Advanced knowledge and skill in Excel, Word, and other productivity software required
- Needs to be driven, innovative, independent, self-starter, a leader, team player, analytical intelligence, exceptional attention to detail, aptitude and willingness to learn and drive change
- Healthcare business or insurance knowledge
- Ability to effectively communicate technical information
Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities.
Job Type: Full-time
Pay: $18.00 per hour
- Dental insurance
- Disability insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Day shift
- Monday to Friday
- TherapyNotes and/or Valant EHR: 2 years (Preferred)
- medical billing: 5 years (Required)
- Excel, Word, and other productivity software: 1 year (Required)
- Healthcare business or insurance: 3 years (Required)
- Bachelor's (Preferred)
This Job Is Ideal for Someone Who Is:
- Dependable -- more reliable than spontaneous
- Detail-oriented -- would rather focus on the details of work than the bigger picture
- Autonomous/Independent -- enjoys working with little direction
This Company Describes Its Culture as:
- Outcome-oriented -- results-focused with strong performance culture
- People-oriented -- supportive and fairness-focused
- Team-oriented -- cooperative and collaborative
Company's Facebook page:
- Waiting period may apply
- Temporarily due to COVID-19