RCM Specialist
Full Time ₱19,000 - ₱22,600 / monthJob Overview
We are looking for a highly organized and detail-oriented Revenue Cycle Management Specialist to join our growing team. This role plays a critical part in ensuring accurate billing, authorization management, and payer compliance. The ideal candidate will have strong analytical skills, at least basic Excel skills, and experience navigating various healthcare payer portals.
Key Responsibilities
- Data Entry & Verification:
- Accurately enter authorizations and required billing fields.
- Verify data across multiple systems including Billing System, CRM, Excel, and Healthcare Payer Portals.
- Payer Requirements:
- Understand and fulfill varying payer requirements, ensuring contractual obligations are met.
- Collaborate effectively with the RCM department.
- Problem-Solving & Research:
- Identify issues in standard operating processes and recognize patterns that deviate from expected procedures
- Research and address non-standard scenarios in the process.
- Communicate effectively with internal and external stakeholders.
- Account Management:
- Process adjustments on account ledgers and manage missing/expired or reach out to obtain correct authorizations.
- Handle outbound calls, terminations, and payer changes.
Skills, Knowledge & Expertise
Advanced Excel Skills
- Proficient in PivotTables, VLOOKUP, MATCH functions
- Skilled in standard operations including cut/paste, filter, sort, and formatting
HIPAA Compliance
- Adheres strictly to HIPAA and PHI guidelines
Contractual and Payer Compliance
- Stays up to date on contractual and payer changes to ensure full compliance
Experience in Payer Portals
- Hands-on experience with:
- Availity
- United Healthcare
- Centene
- Blue Cross Blue Shield
- Aetna
- Hands-on experience with: