Revenue Cycle Management Specialist I

Legacy Community Health is a premium, Federally Qualified Health Center (FQHC) that provides comprehensive care to community members regardless of their ability to pay. Our goal is to treat the entire patient while improving their overall wellness and quality of life, in addition to providing free pregnancy tests, HIV/AIDS screening. At Legacy, we empower patients to lead better lives by promoting healthy behaviors and offering resources such as literacy classes, family planning services, and nutrition and weight management information.

Our roots began in 1981 as the Montrose Clinic, with specialization in HIV education, testing, and treatment. Since then, the agency has expanded to >50 clinics in Houston, one in Baytown, two in Beaumont, and one in Deer Park with extensive services that include: Adult primary care, HIV/AIDS care, pediatrics, OB/GYN and maternity, dental, vision and behavioral health. We also service students within KIPP and YES Prep schools. Legacy is committed to driving healthy change in our communities.

Job Description

RCM Specialist I will work in a corroborative, team environment by establishing strong working relationships with department, patients, payors, providers and clinic staff. The representative must also display strong detailed oriented skills with the proven ability to multitask. Insurance and medical terminology will be used daily. Basic knowledge of insurance carrier guidelines is required. Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to insure a professional, responsible and courteous environment.

Essential Functions

• Assesses accuracy of demographic and policy information within patient accounts and updates as needed

• Scan/photocopy patients' identification, insurance cards and correspondence as appropriate.

• Responds to correspondence and phone calls related to patient accounts and is available to answer billing and charge related inquires by patients, staff, managed care organizations, etc., in a timely manner.

• Communicates daily with internal and external customers via phone calls and written communications.

• Documents all communication and transactions in patient accounts accurately and completely

• Assists in patient collections and reconciling deposit.

• Responsible for verification of patient insurance eligibility and authorization requirements daily.

• Determine individual insurance plan benefits for scheduled exams/testing for all service types.

• Obtain any required clinical history from referring physician in order to obtain authorization.

• Adheres to Documentation Guidelines pertaining to all eligibility, authorization, and determination of benefits information

• Communicate with patients and/or referring physicians on non-covered benefits or exam coverage issues.

• Communicate with patients and front office team on patient financial responsibility.

• Provide guidance to Clinic Staff, Scheduling Staff, and other appropriate Departments regarding Authorization and Eligibility.

• Stay informed; establish method and communicate any updates and/or changes in Payor authorization processes and requirements.

• Works independently.

• Pursues and participates in education to remain current with changes in the Healthcare industry.

• Maintains patient confidence and protects medical office operations by keeping patient information confidential.

• Contributes to team effort by accomplishing related results as needed.

• Communicates with Leads to identify and resolve all RCM issues.

• Works remote with some physical presence in office for team meetings &/or special projects. Must maintain productivity standards and performance goals in order to remain in WFA environment

• Performs other duties as assigned.

Education & Training Requirements

• High School diploma or equivalent.

Work Experience Required

• 1-2 years of related medical revenue cycle experience

• Previous experience in a medical revenue cycle setting and familiar with the insurance verification processes including some training in ICD10/CPT Codes preferred

• EPIC Certification preferred but not required

• Basic Excel proficiency

Benefits

• Medical / Vision / Dental

• 9 Holiday + 1 Floating Holiday

• 403b Retirement Plan

• Paid Time Off (PTO)

• PTO Exchange benefit

PTO Exchange will provide you with the option to convert a portion of your accrued but unused PTO hours for use toward several different benefits and causes, based on your own priorities.

With PTO Exchange, you can convert a portion of your unused PTO into:

• 403(b) Retirement contributions

• Student loan payments / Tuition for the employee

• Leave Sharing donations to fellow employees