RCM Specialist

Welcome to Veradigm! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Veradigm is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information.

Veradigm

Welcome to Veradigm! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Veradigm is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information.We are an Equal Opportunity Employer. No job applicant or employee shall receive less favorable treatment or be disadvantaged because of their gender, marital or family status, color, race, ethnic origin, religion, disability or age; nor be subject to less favorable treatment or be disadvantaged on any other basis prohibited by applicable law.For more information, please explore Veradigm.com.

What Will Your Job Look Like

This position has a three-part of Accounts Receivable follow-up, Payment Posting and Charge Entry processing. As such, the position is responsible for the overall recovery and management of the clients' Revenue Cycle. Along with the responsibilities associated with accurately entering charges, posting payments and the subsequent recovery of revenue, the position optimizes all phases of RCM. Additionally, provides training and support to other team members. Supports the RCMS BU's overall Operations and Client Services departments by efficiently and effectively driving the Revenue Cycle Management process and achieving KPI results. No budget responsibilities; must meet established RCM KPI's.

Main Duties

Strong customer service skills for client satisfaction and client AR health.

• answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for information.
• Timely management of unpaid claims as assigned, through the use of the client’s office management/administrator.
• Aging reports; correspondence; Clearinghouse and PM rejections; SharePoint reference/maintenance.
• Effectively handles complex payer denials; responsible to ensure that secondary claims are processed and paid.
• Monitoring and reconciliation of claims.
• Timely posting of payments and identifying adjustments and differences in payments.
• Expert ability to input specific data and review patients’ issues and credits.
• Knowledgeable of medical EOB’s, patient deductibles and co pays, and insurance or third party correspondence.
• Ability to conduct a contract rate audit and provide notification to RCM Management of underpaid or pay equal charges; provide Claim Edit Reports and Unassigned Money Reports as requested.
• Effectively work with clients and others to facilitate information and resolve charge questions.
• Creates credit/debit reports and denial reports in order to provide critical information to the others.
• Expert ability to add specific data such as modifiers, payer specific information, including authorization criteria, CPT and ICD codes and date of injury (DOI).
• Understands and interprets the Correct Coding Initiative (CCI) as it applies to charge entry work.
• Timely and efficient entry and reconciliation of batches.
• Processes and conducts discrepancy reconciliation and closing of charge batches across all systems.
• Works with clients and others to facilitate information and resolve charge questions.
• Achieves goal of a 48-hour turnaround batch time.
• Achieves goals set forth by RCM Management regarding error-free work, transactions, processes,
  

productivity and compliance requirements. Specific goals include 1,400 accounts worked per month.

• Other duties as assigned.
  

Academic Qualifications

• High School Diploma or GED (Required)
  

An Ideal Candidate Will Have

1+ year relevant work experience (Preferred)

• Technical: Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites and Laserfiche; knowledge and use of Microsoft Products: Outlook, Word, Excel. Preferred experience with various billing systems, such as NextGen, Pro and Allscripts.
• Personal: Strong written, oral, and interpersonal communication skills; Ability to present ideas in business-friendly and user-friendly language; Highly self-motivated, self-directed, and attentive to detail; team-oriented, collaborative; ability to effectively prioritize and execute tasks in a high-pressure environment.
• Communication: Ability to read, analyze and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints from employees and clients. Ability to speak clearly and to make effective and persuasive arguments and presentations.
• Math & Reasoning: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to use critical thinking skills to apply principles of logic and analytical thinking to practical problems.
  

Work Arrangements: Work from Pune Office all 5 days.

Shift Timing: 7:30 PM IST to 4:30 AM IST (US Shift)

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish.

• Quarterly Company-Wide Recharge Days
• Peer-based incentive “Cheer” awards
• “All in to Win” bonus Program
• Tuition Reimbursement Program
  

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -
https://veradigm.com/about-veradigm/careers/benefits/https://veradigm.com/about-veradigm/careers/culture/Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.Thank you for reviewing this opportunity! Does this look like a great match for your skill set? If so, please scroll down and tell us more about yourself!