Job Description
ResponsibilitiesCome and join the RMC Family!
We have been in the community since 5. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care.
SUMMARY: Responsible for the accurate and timely processing of fee-for-service claims and account collections.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE: High school diploma or general education degree required. Knowledge of medical terminology required. Two years prior experience in medical billing/collections is REQUIRED.
CERTIFICATES, LICENSES, AND REGISTRATIONS: None.
ESSENTIAL FUNCTIONS:
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: Other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing.
1. Assist the supervisor as requested.
2. Review, adjust, and/or mail out all assigned tracer claims
3. Initiate claim review and/or appeals, as indicated on assigned explanation of benefits.
4. Review, adjust, and/or process all assigned correspondence.
5. Work aging AR:
a. Contact insurance carrier to check on claim status and/or responsible party to settle account.
b. Review Explanation of Medical Benefits to verify accuracy of reimbursement
c. Verify insurance coverage
d. Initiate necessary account adjustments, change of charges and/or refunds as indicated.
6. Analyze and investigate denied claims to determine the root cause of denials, including coding errors, missing information, and billing discrepancies.
7. Prepare and submit appeals for denied claims, utilizing a comprehensive understanding of payer requirements and regulations to maximize the likelihood of successful resolution.
8. Resubmit corrected claims with the appropriate documentation and follow up to ensure timely processing.
9. Communicate with insurance companies, payers, and other relevant parties to resolve denials and obtain information needed for appeals and/or resubmission.
. Maintain regular follow-up with insurances and responsible parties to track the progress of appealed claims and pending actions. Escalate as necessary to achieve successful resolution.
. Stay informed about industry changes, billing regulations, and payer policies to ensure compliance with applicable laws and best practices.
. Manage and resolve claims with pending responses from insurance companies and/or other parties.
. Track and follow up on unpaid claims and/or incomplete documentation.
. Review account with no response and communicate with relevant parties to obtain necessary information
. Document all interactions and actions taken.
. Display a professional attitude through performance, appearance, and demeanor.
This opportunity offers the following:
Challenging and rewarding work environment
Growth and Development Opportunities within UHS and its Subsidiaries
Competitive Compensation
About Universal Health Services
ACCOUNTS RECEIVABLE SPECIALIST- Full Time • RIVERSIDE, California
Under the Manager, Guest Recovery, the Guest Recovery Specialist holds responsibility for the guest experience through the response to guest feedback provided through all feedback avenues.Analyzes ... Show more
We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up... Show more
Oversee and help manage the accounts receivable and accounts payable process.Oversee invoice processing, vendor payments, 1099 reporting, and expense management (T&E).Perform complex reconciliation... Show more
Collections Engagement Specialist.As a Collections Engagement Specialist, you will work closely with the Collections Operations Analyst to monitor the company's Accounts Receivable ledger to identi... Show more
Payables Vendor Relations Specialist/h2pindiGO Auto Group is a globally recognized and award-winning company with an unparalleled dedication to outstanding customer care and operational excellence... Show more
We're currently looking for individuals across the country to take part in remote paid research, including remote focus groups, product trials, and consumer studies.Earn up to $750 a week in your f... Show more
Under the Manager, Guest Recovery, the Guest Recovery Specialist holds responsibility for the guest experience through the response to guest feedback provided through all feedback avenues.Analyzes ... Show more
READ BEFORE APPLYING - This Might Just Change Your Life!We're on the hunt for driven, coachable, and high-energy individuals who are ready to level up and work with top leaders in the financial ser... Show more
We're currently looking for individuals across the country to take part in remote paid research, including remote focus groups, product trials, and consumer studies.Earn up to $750 a week in your f... Show more
Account Specialist Job Duties: Prepares work to be processed by gathering, sorting, organizing, and recording data, information, and documents.Co... Show more
We’re looking for Customer Support Product Testers across the US to work from home and help top brands improve their products before they hit the market. Show more
DataAnnotation is committed to creating high-quality AI.Join our team to help train the next generation of AI while enjoying the flexibility of remote work and the freedom to set your own ... Show more
Remote Healthcare Talent Account Specialist.Embark on a transformative journey as a healthcare talent account specialist make connections that count from anywhere!.What if your next career decisio... Show more
Collections Specialist Remote Job Duties: • Meet the defined productivity metric of a minimum of 30 daily claim touch... Show more
Travel Booking Specialist – Remote.In this role, you will help promote travel experiences, support marketing initiatives, and assist with connecting travelers to vacation opportunities.This opportu... Show more
Thank you for your interest in a career at Regions.At Regions, we believe associates deserve more than just a job.We believe in offering performance-driven individuals a place where they can build ... Show more
We're looking for candidates with great customer service skills to fill our Remote Customer Service role!.This role is entirely remote and offers full-time/Part time hours with flexibility.We are r... Show more
Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Call Center Representative Agent experienc... Show more
Note : This is an educational program, not a job.Successful completion of the program does not guarantee employment but will equip you with valuable skills for the healthcare job market.Looking to ... Show more
At Chase, we are passionate about creating memorable experiences for our clients and employees, making them feel welcomed, valued, and understood.We build lasting relationships by doing the right t... Show more
