RCM AR Specialist

BostonRemoteFull-timemid

OtherRcm Ar Specialist

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Quick Summary

Overview

Who we are: At Better Life Partners, we provide what it takes to heal from addiction. Wherever. Whenever. We work alongside community-based organizations to meet our members where they are,

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OtherRcm Ar Specialist

Who we are:

At Better Life Partners, we provide what it takes to heal from addiction. Wherever. Whenever.

We work alongside community-based organizations to meet our members where they are, no matter what recovery looks like to them. By combining virtual and in-person counseling, community support, and access to life-saving medication, we help people move beyond addiction to find belonging, love, and purpose.

If you’re looking to roll up your sleeves and meet hard challenges head-on, then we’re looking for you.

The role:

The RCM AR Specialist is responsible for all workflows related to the back-end billing and collections cycle for Better Life Partners. The position requires expertise in the life cycle of medical claims, knowledge of payer regulations, both local and national payers, and the ability to work efficiently within our internal EHR system and practice management system.

To be successful in this role, you should be able to have very acute attention to detail and be able to provide excellent customer service. Strong communications skills to include direct contact to the appropriate third-party payers and members as needed. You are excited about our mission and committed to helping people through a sometimes difficult system.

Unless otherwise specified, this position is remote (work from home) with expectation of attending team meetings quarterly. Candidates must reside in one of the following states: Maine, Maryland, Massachusetts, New Hampshire, New Jersey, North Carolina, Pennsylvania, Rhode Island, or Connecticut.

Review denied claims based on assigned markets, payers and work queues within our practice management system

Accurately and efficiently processes requests for denied claims information using website portals and outbound phone calls for all Commercial, Medicare and Medicaid insurance payers

Researches and responds to documentation requests from insurance carriers in a timely manner

Processes appeals of insurance denials and follows-up until the appeal is resolved

Obtains, reviews and updates patient demographics and insurance information within both EHR and practice management billing system as needed

Complete timely follow-up on claims submitted to payer, but no response or ERA after 45 days to resolve any pending issues with claim and payer within timely filing limits

Documents clear and concise activities performed in the system for each account worked

Adheres to all HIPAA (Health Insurance Accountability and Portability Act) guidelines and regulations

Ability to consistently maintain productivity and quality expectations as defined by the leadership team

Alert management to irregularities, insurance trends and areas of concern with reimbursement

Completes other tasks and projects as assigned by RCM Leadership

Bachelor's Degree or Equivalent experience

3 or more years of experience in physician group practice in a denial management role

Prior experience resolving out of network denials, and value based (bundle) claims

Proficient in CPT and ICD-10 coding terminology

Enjoy working in a fast paced and rapidly changing environment

Strong relationship building skills both external and internal

Thrive on working independently

Familiar with opioid use disorders, substance abuse use disorders and other areas of behavioral health billing

Certified Medical Coder, CPC or CCS, preferred but not required

Deep knowledge of medical insurance payers and regulations

Knowledgeable in the healthcare & mental health industries - terminology, regulations, and processes

Familiar with all aspects of the RCM Life cycle as it relates to claim reimbursement

BLP operates in hybrid and remote work environments, which allows us to better meet our members and partners where they’re located. Candidates applying for this role must be willing and able to travel locally within the communities we serve and/or travel to onsite meetings as expected in coordination with their department and business needs.

Must have reliable internet service with a fast upload/download ability

Ability to ensure any protected health or proprietary data/information is not visible (or audible) to others in any work location

Must have a quiet space to speak to members, team members, or external partners with minimal background noise and distractions