The Senior RCM Specialist is responsible for Practice-level RCM operations, including prior authorization, coding, charge entry, billing, patient collections, denials management, and ensuring the Practice receives all payment it is entitled to for the services it provides. Although this is an individual contributor role, the position will work closely with front-office staff in our practices and have hands-on responsibility for implementing and continuously improving all RCM functions.

The Senior RCM Specialist will be part of the Advantia Central Billing Office (CBO) team, reporting to the VP of RCM, and will likely focus on certain specific Practices at any given time.

The Senior RCM Specialist is responsible for achieving Practice-level RCM targets for metrics including cash collection, patient responsibility collection, Days Sales Outstanding (DSO), denial rate, and others.

The Senior RCM Specialist achieves these Practice-level RCM targets, by working with Practice leadership and staff; outsourced RCM vendors; EMR and other technology vendors; and Advantia corporate and RCM leadership; to drive ongoing continuous improvement of Practice-level RCM results. This role is a hybrid position that requires 50% travel.

Job Responsibilities:

Promotes and supports a working environment consistent with the standards, values and culture of Advantia.
Works with Practice operations staff to obtain prior authorization, review coding and charge entry, review and release claims, ensure time-of-service collections of patient financial responsibilities, support denials management efforts, and ensure the Practice receives all payments entitled for services provided.
Reviews substantial sample of claims (or all claims, depending on size of practice assigned) to ensure that claims being billed are accurate and complete.
Works with CBO leadership and staff to analyze RCM workflows, identify and troubleshoot problems, propose and identify solutions, draft Standard Operating Procedures (SOPs), and train colleagues in SOPs.
Analyzes data/metrics, to spot trends and opportunities for RCM interventions and improvements.

Provides and supports project management and implementation of RCM performance improvement initiatives, at the Practice level.

Will initially be assigned to, and be required to be on-site as needed to support, practice locations in IL and MO to deeply understand and continuously improve Practice level RCM workflows and revenue-cycle processes. Longer term, the role will support Practices in the MIdatlantic.
Build collaborative trusting relationships with physicians, practice managers, operations staff, and other Advantia team members.
Other duties as assigned.

Job Requirements:

Must have 5-7 years of experience in Physician Practice Management (PPM) RCM
3+ years experience with Athena Electronic Medical Record (EMR) system strongly preferred
Medicaid and Medicaid Managed Care experience, especially with Illinois and Missouri
Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) Preferred but 2-3 years hands on experience working as a physician medical coder will be considered.
Experience with Phreesia online patient visit registration and payment system, is preferred but not required
Experience working with vendors of outsourced RCM services including vendors with offshore staff.
Works independently / under general supervision, good at prioritizing tasks and communicating proactively
Team player
Passionate commitment to regulatory compliance, patient and family customer service, and supporting clinical quality
Bachelors degree in healthcare administration a plus but not required.

Please note: Advantia Health is dedicated to providing unparalleled healthcare to our customers by employing the most highly qualified individuals. If you are selected for further consideration, you will be subject to a background investigation. COVID-19 and Flu vaccination is a required condition of employment.

Advantia Health is an Equal Opportunity Employer that is committed to global diversity: It is a place where good people want to work, and customers want to continue to engage EOE M/F/D/V.