MD Ally Revenue Cycle Management (RCM) Specialist Remote · Full time

The Revenue Cycle Management (RCM) Specialist will be responsible for managing and optimizing the financial aspects of the healthcare revenue cycle. This includes overseeing coding processes to ensure accurate and compliant billing, as well as addressing issues related to claims, payments, and denials.

Description

Overview:


Our mission at MD Ally is to revolutionize emergency healthcare by seamlessly

integrating creative telehealth solutions into the 911 response system and creating a

healthcare landscape where telehealth interventions become an integral part of

emergency response to reduce the cost of care and improve overall outcomes.


The Revenue Cycle Management (RCM) Specialist will be responsible for managing

and optimizing the financial aspects of the healthcare revenue cycle. This includes

overseeing coding processes to ensure accurate and compliant billing, as well as

addressing issues related to claims, payments, and denials.


What We Are Looking For:


Knowledge of Tele-Healthcare: The ideal candidate will have a strong understanding

of the entire healthcare revenue cycle, including patient registration, coding, billing,

payment posting, denial management and reporting.


Experience with Billing Software: Competence with billing and coding software

systems (Availity, CAQH, PECOS, Payspan, etc.) commonly used in healthcare

settings. Proficiency in using electronic health records (EHR) and billing software is

critical to success in this role.


Attention to Detail: The revenue cycle involves complex financial transactions, so

attention to detail is crucial to ensure accurate billing and reimbursement.


Analytical Skills: The ability to analyze financial data, quickly identify trends, and

make data-driven decisions is important to optimize the revenue cycle process.


Communication Skills: Highly effective verbal and written communication with both

internal staff and external stakeholders, including insurance companies and patients,

is necessary for resolving billing inquiries and addressing payment issues.


Regulatory Compliance: Stay updated on healthcare regulations and compliance

requirements, including HIPAA, CMS, HCPCS, ICD-10 annual updates, and other

relevant laws affecting revenue cycle management.


Problem-Solving Skills: The ability to independently troubleshoot issues, resolve

billing discrepancies, and implement process improvements is important for

streamlining revenue cycle operations.


Adaptability: The healthcare industry and billing practices can change, so candidates

who are adaptable and can quickly learn and implement new processes are valuable.


Key Responsibilities:


As the RCM Specialist reporting up to the VP of Clinical Operations you will focus on,

but not be limited to, the following:


Medical Coding:


● Assign accurate ICD-10, CPT, and HCPCS codes to medical diagnoses and

procedures.

● Ensure compliance with federal, state and local coding guidelines, regulations,

and payer requirements.

● Regularly update coding knowledge to stay informed about industry changes.

● Maintain an up-to-date CPC certification plus any other relevant certifications

for your role.


Revenue Cycle Optimization:


● Identify opportunities to enhance revenue cycle efficiency and minimize

billing errors.

● Collaborate with billing and coding team members to streamline processes.

● Implement best practices for claims submission and payment posting.

● Maintain the Days in Account Receivable (DAR) to align with organizational

and industry standards.

● Actively participates in strategic planning for, and evaluation of, increased

revenue opportunities.


Claims Management:


● Review and analyze insurance claims for accuracy and completeness.

● Address and resolve issues related to claim rejections or denials.

● Monitor claims status and take necessary actions to expedite payment.

● Manages weekly and monthly reporting


Documentation Compliance:


● Ensure documentation supports the codes assigned for billing purposes.

● Collaborate with healthcare providers to improve documentation accuracy.

● Stay updated on coding and documentation guidelines.

Communication and Training:

● Communicate effectively with internal teams, healthcare providers, and

insurance companies.

● Provide training and guidance to staff on coding and billing regulations.

● Foster a culture of compliance, quality assurance, and continuous process

improvement.


Audit and Compliance:


● Conduct regular audits to ensure coding accuracy and compliance with

regulations.

● Stay informed about changes in healthcare laws and regulations.

● Implement corrective actions based on audit findings.

● Serves and protects MD Ally’s interests by adhering to professional standards,

policies and procedures, federal, state, and local requirements and standards.


What You Will Bring:


● CPC (Certified Professional Coder) certification is required.

● 3-5 years of experience in medical coding and revenue cycle management is

required; experience with telehealth is preferred.

● Strong knowledge of ICD-10, CPT, and HCPCS coding systems.

● Ability to create and maintain a strong culture of collaboration and cross-functional teamwork within the organization and with external payer

partnerships.

● Self-starter with strong attention to detail and an innate drive to achieve or

surpass organizational revenue goals.

● Excellent written and verbal communication and interpersonal skills.

● Analytical skills to assess and improve RCM performance through

performance metrics and benchmark reporting.

● Ability to adapt to a fast-paced and dynamic healthcare environment.


Benefits:


● Medical, Dental, Vision

● Generous Paid Time Off and Sick Time

● Paid Holidays + extra hours to use on your holiday of choice

● Equity in the form of stock options

● Leadership and professional growth opportunities

● Continuing Education