What You’ll Do – Job responsibilities

The Revenue Cycle Management (RCM) Specialist is responsible for overseeing the entire billing and payment process within a healthcare organization. Their duties include verifying patient insurance, processing claims, tracking payments, handling denials, and ensuring accurate and timely reimbursement. They work closely with medical staff, insurance companies, and patients to resolve billing issues, ensure compliance with healthcare regulations, and optimize revenue. Strong analytical, communication, and problem-solving skills are essential in this role to maintain efficient financial operations. Essential responsibilities of this role include, but are not limited to:

• Insurance Verification: Verify patient insurance eligibility and benefits through payer portals and eligibility tools ahead of scheduled visits; confirm active coverage, plan type (including D-SNP/dual status), and PCP assignment; resolve discrepancies with payers and centers; and accurately document and tag coverage in Collectly to reduce denials and ensure correct attribution.
• Charge Entry: Accurately enter and code medical charges based on the services provided, ensuring proper use of ICD-10, CPT, and HCPCS codes.
• Claims Submission: Prepare and submit insurance claims electronically or via paper, adhering to payer requirements and ensuring completeness and accuracy.
• Rejections: Review rejections in Elation and in PMS. Resolve and resubmit rejected claims.
• Denial Management: Review and manage claim denials and rejections. Investigate the cause of denials, correct errors, and resubmit claims as necessary.
• Accounts Receivable: Monitor and manage accounts receivable, including following up on unpaid claims, contacting payers for status updates, and resolving payment issues.
• Patient Billing: Generate and send patient statements. Address patient inquiries regarding bills, payments, and insurance issues. Establish payment plans if necessary.
• Compliance and Documentation: Ensure compliance with federal and state regulations, as well as payer-specific requirements. Maintain accurate and organized billing records and documentation.
• Reporting: Generate and analyze billing reports to track performance metrics, identify trends, and recommend improvements to the billing process. Publish billing KPIs on a monthly basis.
• Collaboration: Work closely with healthcare providers, insurance companies, and internal teams to resolve billing issues and improve processes.

What You’ll Bring - Education Requirements

• High School / GED required
• Medical Billing & Coding Certification preferred

What You’ll Bring - Experience Requirements

• 3 + years of end-to-end billing experience
• Value Based care experience preferred
• Attention to detail and intermediate excel skills required

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard to 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.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Who We Are

At Suvida Healthcare, we are not just caregivers; were compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well-being of an underserved community and their families. Our multi-disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare-eligible Hispanic seniors. 

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both, our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service-centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos, to help achieve our Higher Purpose?

What Makes Us Unique

We are an empowered primary care team, clinical operations, and support team creating health equity through an exceptional clinical and consumer experience that improves the quality of life for the people, families, and neighborhoods we serve. We tailor our primary care program to the culture, language, social, and overall well-being of the seniors we serve. 

How We Work

Our Culture & Core Beliefs

• Earn Trust
• Building Relationships
• Creating Joy
• Doing Right
• Improving Every Day
• Moving Forward

Our Promise

• Purpose Driven Career
• Competitive Pay
• Best-In-Class Medical/Dental Coverage 
• Free Mental Health & Life Coaching for Team Members and their Dependents
• Holiday Time Off with Pay
• Paid Community Service Day
• Paid Parental/Family Leave
• Paid Bereavement Leave
• Generous Paid Time Off (PTO)
• 401k Retirement Plan with Company Match
• And much more....