Position Summary

The Lead, Revenue Cycle Management Specialist is the subject matter expert for accounts receivable and will be responsible for assisting the management team with leadership oversight of the RCM domestic and global teams in a fast-changing environment. This individual will provide work assignments, feedback, training, and guidance to ensure RCM staff follows department protocol with RCM processes. The Lead for RCM will handle escalated phone calls from patients or insurance companies that cannot be effectively resolved by staff. This individual will work closely with supervisors and management to identify payor trends and develop RCM process improvements.

Essential Functions and Job Responsibilities

• Train, mentor, guide, and provide oversight assistance to the RCM team while supporting all domestic and global RCM team members
• Apply subject matter expertise in evaluating business operations and processes
• Identify areas where technical solutions would improve business performance
• Consult across teams, provide mentorship, and contribute specialized knowledge
• Demonstrate various techniques and documentation to streamline production processes
• Identify team member strengths and opportunities and report findings to supervisors
• Assume responsibility for resolving team member escalations by working with multiple business partners while maintaining consistent communication with the member
• As a Subject Matter Expert, train new employees and continue development for all team members to ensure company policies and procedures are being followed
• Take escalated phone calls that cannot be effectively resolved by team members
• Communicate with other departments, including front-end staff, regarding billing issues and trends to work toward account resolution and decrease insurance denial percentages
• Assist with insurance payer disputes that are filtered into the department
• Identify trends and root causes related to inaccurate insurance billing and report to manager while resolving account errors
• Assist in conducting team meetings to educate on insurance guidelines, claim denials, and re-training efforts on accounts incorrectly worked
• Develop and enhance process and payer-specific work job aids and standard operating procedures
• Investigate escalated insurance billing inquiries and inaccuracies and take appropriate action to resolve the account
• Provide quality payer feedback to other company leadership
• Develop and maintain working knowledge of current company products and services offered
• Maintain patient confidentiality and function within the guidelines of HIPAA
• Complete assigned compliance training and other educational programs as required
• Maintain compliance with the company's Compliance Program
• Perform other related duties as assigned

Competencies, Skills, and Abilities

• Decision making
• Strong analytical and problem-solving skills with attention to detail
• Excellent verbal and written communication
• Excellent customer service skills
• Proficient computer skills and knowledge of Microsoft Office
• Ability to prioritize and manage multiple projects
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
• Understanding and identifying priority orders
• Extensive knowledge of products offered and the required paperwork to ensure proper billing for those products
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form

Education and Experience Requirements

• High School Diploma required; Associate degree preferred
• Three (3) years' related work experience in healthcare administrative, financial, insurance, customer services, claims, billing, call center, or management regardless of industry required
• Two (2) years' experience in HME, Diabetic, home medical supplies, Pharmacy, or home health environment is preferred
• Exact job experience is considered any of the above tasks in a Medicare-certified HME, IV, or home health environment that routinely bills insurance

Physical Demands and Work Environment

• Work environment may be stressful at times, as overall office activities and work levels fluctuate
• Must be able to bend, stoop, stretch, stand, and sit for extended periods of time
• Subject to long periods of sitting and exposure to computer screen
• Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use
• Mental ability to convey knowledge and mentor others
• Mental ability to analyze information, problem solve, and identify areas of opportunity
• Must be able to lift 30 pounds as needed
• Excellent ability to communicate both verbally and in writing
• May be exposed to angry or irate customers or patients

Amazing Benefits At A Glance

• Team Driven and Values-Based Culture
• Medical, Dental, and Vision Benefits
• Paid Time Off (PTO), Holiday Pay, Sick and Safe Time for Applicable States
• Employee Assistance Program
• Career Growth Opportunities
• 401(k) and Generous Employer Match Opportunity
• $22.00 - $26/hour based on experience

Equal Opportunity Statement

At ActivStyle, we don't just accept difference - we celebrate it, we support it, and we thrive on it for the benefit of our team and our community. We are proud to be an equal opportunity workplace and an affirmative action employer.

This employer participates in E-Verify. Following acceptance of any job offer, at the start of employment the employer will provide the federal government Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify is unable to verify your eligibility for employment, this employer will provide written instructions to provide an opportunity to contact the appropriate agencies and resolve the discrepancy prior to taking any action against continued employment.