RCM Specialist- Home Health and Hospice

Job Summary: The RCM Specialist for Home Health & Hospice plays a crucial role in ensuring the efficient and accurate processing of claims and patient accounts, contributing to the organization's financial health. They possess a comprehensive understanding of revenue cycle processes and demonstrate expertise in resolving complex claims and patient billing issues. Essential Duties and Responsibilities: Lead and optimize the full revenue cycle process from billing the claim to final payment collection. Collaborate with the RCM team to maintain a clean and compliant revenue cycle. Generate claims accurately from EMR system to clearinghouse and monitor the claim following HRP standard protocol. Resubmit claims corrected as needed and communicate issues that need to be resolved. Communicate unbilled and billed claim holds to Team Leader or RCM Manager. Analyze and resolve complex claims denials and appeals. Investigate and address patient billing discrepancies and disputes. Identify and implement strategies to improve revenue cycle performance as needed. Collaborate with cross-functional teams to implement and manage assigned RCM accounts. Participate in revenue cycle audits and compliance reviews (quality review checks). Develop and maintain accurate and up-to-date documentation of all claims and patient accounts. Provide training and support to other RCM team members. Key Performance Indicators (KPIs): Clean claim rate >95% Aged AR 95% Meets and passes 100% of quality review checks completed by RCM Manager Qualifications: 3–5 years of experience in revenue cycle management in the home health and hospice realm Proficient in Microsoft Office Suite 365 Proficient in home health and hospice electronic health records (EHR) systems Strong understanding of insurance billing and coding procedures Excellent communication, problem-solving, and analytical skills Ability to work independently and as part of a team Proven track record of success in resolving complex claims and patient billing issues Benefits: Competitive salary and comprehensive benefits package, including health insurance, dental insurance, vision insurance, paid time off, and 401k savings plan Opportunity to work in a dynamic and growing healthcare organization Professional development and training opportunities Contribution to the organization's financial success and patient satisfaction