RCM Specialist Collections

Summary

KPH Healthcare Services, Inc. is seeking an RCM Specialist focused on collections and revenue cycle operations. The role manages outstanding claims, resolves denials and payment issues, communicates with payers and patients, maintains accurate records, supports process improvement, and ensures regulatory compliance.

Responsibilities

• Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence
• Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions
• Collaborate with internal teams to address claims challenges and improve revenue cycle
• Escalate complex or uncollectible accounts to management for further action
• Submit appeals/claim corrections as needed within timely filing limits
• Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients
• Payer projects as assigned
• Identify and report trends in claim denials and payment challenges
• Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about billing
• Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments
• Assist in the implementation of processes to measure, assess, and improve the performance of the RCM department activities of the company
• Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement "best practices" in all departmental activities
• Participate in surveys conducted by authorized inspection agencies
• Participate in the company's Performance Improvement program as requested by the Performance Improvement Coordinator
• Participate in company committees when requested
• Participate in in-service education programs provided by the company
• Pursue continuing education programs appropriate to job responsibilities
• Perform other duties as assigned by supervisor
• Complete all mandatory and regulatory training programs
• Report any misconduct, suspicious or unethical activities to the Compliance Officer
• Complies with accepted professional standards and practice