RCM Representative Sr, Third-Party Claims - HB & PB

SUMMARYWe are currently seeking an RCM Representative Senior to join our Third-Party Claims- HB & PB team. This full-time role will primarily work on-site (SHIFT: Day). Purpose of this position:Working under general supervision, provides revenue cycle services to incoming and existing patients and their families either in person or by telephone. Responsible for gathering patient information needed to provide services such as following up on complex claim issues, financial clearance, customer service or admission. Work will be assigned via a work queue in the electronic health record system.//RESPONSIBILITIES

Gathers information from patients, clients/family members, HCMC clinical areas, government agencies, employers, third party payors and/or medical payment programs, etc. both in-person and by telephone to register patients, gather or update information, obtain referrals and pre-authorizations, complete appropriate forms, conduct evaluations, determine benefits and eligibility (insurance, public programs, etc.), determine financial responsibility and/or to identify sources of payment for services

Requests, inputs, verifies, and modifies patient’s demographic, primary care provider, and payor information

Utilizes tools, including computer programs, when indicated

Makes appropriate referrals (i.e. Patient Financial Care Specialists, Collections Specialists) as appropriate

Provides excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc.

Answers questions (by phone and in-person) and provides quotes for services (including discounts), identifies financial resources, etc. in accordance with HCMC policies and procedures

Utilizes various databases and specialized computer software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review/updating of patient accounts, etc.

Establishes plans (patient liabilities, payment, etc.) and conducts follow up activities related to those plans

Inputs, retrieves, and modifies information and data stored in computerized systems and programs; generates reports using computer software

Explains charges, answers questions, and communicates a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agencies

Works with Claims and Collections (both internally and with collection agencies) in order to assist patients and their families with billing and payment activities in order to increase cash flow

Other duties as assigned

QUALIFICATIONS/Minimum Qualifications:/

2 years clerical experience in health care revenue cycle operations: billing/claims, patient accounting, collections, admissions, registration, etc.

Bi-lingual strongly preferred, required in some positions

-OR-

An approved equivalent combination of education and experience

/Preferred Qualifications:/

Demonstrated organizational skills and the ability to prioritize and manage tasks based on established criteria

Excellent verbal and written communication and interpersonal skills

Ability to work independently with minimal supervision, within a team setting and be supportive of team members

Proficient with Microsoft Office

Ability to analyze issues and make judgments about appropriate steps toward solutions

CRCR (Credentialed Revenue Cycle Representative) preferred

/Knowledge/Skills/Abilities:/

Knowledge of patient billing claims process

Ability to communicate with patients and families under sometimes stressful circumstances

Strong telephone communication skills

Experience with electronic health record or similar software program

Knowledge of payor programs

Knowledge of applicable federal and state regulations

Title: RCM Representative Sr, Third-Party Claims - HB & PB Location: MN-Minneapolis-Downtown Campus Requisition ID: 231464