Lead, RCM Specialist

Position Summary

The Lead, Revenue Cycle Management Specialist is the subject matter expert for insurance payer accounts receivables

and will be responsible for assisting the management team with leadership oversight of the RCM domestic and global

teams. This individual will provide work assignments, feedback, training, and guidance to ensure RCM staff is following

department protocol with RCM processes. The Lead for RCM will handle escalated phone calls from patients or

insurance companies that cannot be effectively resolved by offshore staff. This individual will work closely with the supervisor

and management to identify payor trends and develop RCM process improvements.

Essential Functions and Job Responsibilities:

•  Mentors guide and provide oversight assistance to the team. The majority of AdaptHealth RCM team members are located offshore.
•  Applying subject expertise in evaluating business operations and processes.
•  Identifying areas where technical solutions would improve business performance.
•  Consulting across teams, providing mentorship, and contributing specialized knowledge.
•  Demonstrated various techniques and documentation to streamline the production process.
•  Identify team members' strengths and opportunities and report findings to supervisors
•  Respond to internal inquiries for coaching assistance via the subject matter expert queue, office communicator, and email
•  Assume responsibility for resolving team member escalations by working with multiple business partners while consistent communication is present with the member
•  Coach others on how to navigate through systems to find information needed for calls
•  As a Subject Matter Expert, assist with training new employees and assist other CSRs with problems they encountered while interacting with members over the phone; addressed escalated customer questions and concerns
•  Performed ad hoc deep-dive analyses for specific business problems.
•  Training and development of team members to ensure AdaptHealth policy and protocol are being followed.
•  Take escalated phone calls that cannot be effectively resolved by team members.
•  Communicate with other departments, front end staff regarding billing issues and trends to work toward an account resolution and decrease insurance denial percentages within AdaptHealth.
•  Handle all insurance payer disputes that are filtered into the department.
•  Identify trends and root causes related to inaccurate insurance billing, and report to the manager while resolving account errors.
•  Assists in conducting team meetings to educate on insurance guidelines, claim denials, and re-training efforts on accounts incorrectly worked.
•  Develops and enhances the process and payer-specific work job aids and standard operating procedures.
•  Investigate escalated insurance billing inquiries and inaccuracies and take appropriate action to resolve the account.
•  Provides quality payer feedback to other AdaptHealth leadership.
•  Develop and maintain a working knowledge of current AdaptHealth products and services offered by the company.
•  Maintain patient confidentiality and function within the guidelines of HIPAA.
•  Completes assigned compliance training and other educational programs as required.
•  Maintains compliance with AdaptHealth’s Compliance Program.
•  Perform other related duties as assigned.

Competency, Skills, and Abilities:

•  Decision Making
•  Strong analytical and problem-solving skills with attention to detail 
•  Excellent verbal and written communication
•  Excellent customer service skills
•  Proficient computer skills and knowledge of Microsoft Office
•  Ability to prioritize and manage multiple projects
•  Solid ability to learn new technologies and possess the technical aptitude required to understand the flow of data through systems as well as system interaction
•  Understanding and identifying priority orders
•  Extensive knowledge of products offered and the required paperwork to ensure we can bill for those products
•  Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

Education and Experience Requirements:

•  High School Diploma required; Associated degree preferred
•  Three (3) years related work experience in health care administrative, financial, insurance, customer services, claims, billing, call center, or management regardless of industry required
•  Two (2) exact job experience in HME, Diabetic, home medical supplies, Pharmacy, HH environment is preferred.
•  Exact job experience is considered any of the above tasks in a Medicare-certified HME, IV, or HH environment that routinely bills insurance.

Physical Demands and Work Environment:

•  The work environment may be stressful at times, as overall office activities and work levels fluctuate
•  Must be able to bend, stoop, stretch, stand, and sit for extended periods of time
•  Subject to long periods of sitting and exposure to a computer screen
•  Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use
•  Mental ability to convey knowledge and mentor others
•  Mental ability to analyze information, problem solve and identify areas of opportunity
•  Must be able to lift 30 pounds as needed
•  Excellent ability to communicate both verbally and in writing
•  May be exposed to angry or irate customers or patients