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Summary
Title: RCM Specialty Follow Up Specialist
Department: Central Business Office
Location: Security Park – B27

The RCM Specialty Follow Up Specialist ensures all initial third party and federal/state government claims are billed and all unpaid, rejected or denied claims receive appropriate follow up or an appeal to over-turn the denial as required. Specialist is responsible for obtaining missing information, researching denials and documentation, and following up on claims.

Availability Requirements:
• Ability to work 40 hours per week
• Day Shifts between the hours of 7:30 – 5:30
8-hour shifts Monday-Friday
9-hour shifts Monday – Thursday | 4-hour shift Friday

Our Mission: To improve the quality of life for our community by providing the best patient experience for every patient.

Our Vision: To be the best place to work and the best place to receive healthcare.

Benefits: UMC Physicians offers a comprehensive benefits package to eligible full-time employees. Benefits include:
• Paid Time Off
• Sick Pay
• Medical, Dental and Vision Insurance
• Employer Paid Group Life and Voluntary Life Insurance
• Short Term Disability Insurance
• Long Term Disability (after 2 years of employment)
• Critical Illness, Accident and Cancer Insurance
• Health Care and Dependent Care Spending Accounts
• 401K Retirement Plan with Company Match
• Employee Assistance Program
Note: Some benefits require an employee contribution to participate.

Essential Functions:
• Take action to resolve rejected, underpaid, and denied claims by
submitting
corrected claims and appeals on a timely basis upon review of unpaid
encounters.
• Review, research and resolve coding denials for primary care providers;
this
includes denials related to the billed CPT, diagnosis, or modifier.
• Identify and resolve complex claim issues adversely impacting the revenue
cycle to achieve resolution. This requires coordination with clinical
departments and payer consisting of clear and concise written and oral
communication.
• Identification of denial, payment, and coding trends to decrease denials,
improve denial prevention, and maximize collection.
• Contact payers via website, phone, or correspondence, regarding
reimbursement of claims denied.
• Interpret medical rules and policies including payor specific requirements
such as with Medicaid and Medicare to ensure proper reimbursement.
• Maintain compliance with department standards, HIPAA, and governing
agency policies and procedures.
• Additional duties as assigned.

Skills and Abilities:
• Requires knowledge of carrier specific claims appeal guidelines to
includes
claim logic, internet, and paper/fax processes
• Requires proven analytical and decision making to determine what
selective clinical information must be submitted to properly appeal the
denial
• Requires proven knowledge of CPT and ICD-10 coverage policies, internal
revenue cycle coding processes and the billing practices of the specialty
service line
• Requires clear and concise written and oral communication with payors,
providers, and billing staff to ensure resolution of denials
• Requires the ability to read and interpret E&M notes, complex diagnostic
study results, endoscopic and interventional results and/or major surgical
operative notes.
• Determine appropriate action for denial resolution based on
documentation
• Requires proven knowledge of the specialty specific service line
documentation requirements.

Minimum Qualifications:
• High School diploma or equivalent.
• 1 - 2 years of medical billing or collections experience (combination of
higher education and work history may be considered to satisfy this
requirement).
• Type 40 wpm, 10 key by touch.
• Strong attention to detail.

Preferred qualifications:
• Knowledge of carrier specific claims appeal guidelines including claim
logic, electronic, and paper/fax processes.
• Proven analytical and decision making to determine what selective clinical
information must be submitted to properly appeal the denial.
• Knowledge of CPT and ICD-10 codes.
• Ability to read and interpret chart notes to determine appropriate denial
resolution based on documentation.
• Denial management, billing, coding guidelines.
• Previous experience with denials and follow up in primary care.
• Experience in Cardiothoracic, Gastrointestinal, Neurology, Anesthesiology,
or Allergy specialties.

Environmental Conditions:
Works in well-lighted, heated and ventilated building. Exposure to blood borne pathogens are of low risk. Hours of duty may be irregular.

Physical Requirements:
Requires prolonged sitting, some bending, lifting, stooping, and stretching. Hand-eye coordination and manual dexterity sufficient to operate a keyboard, copier, telephone, adding machine, fax machine, printers and other minor office equipment is a must. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Must also be able to communicate in person, via voicemail, vie email and on the telephone.

Limitations and disclaimer:
The above job description is meant to describe the general nature of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. This position is security sensitive.
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UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

*Request for accommodations in the hire process should be directed to UMC Human Resources.​*