Virtual Revenue Cycle Management (RCM) Specialist - Provider Side

The primary responsibilities of a Virtual Revenue Cycle Management (RCM) Specialist at MedVA include overseeing the billing and claims management processes, verifying patient insurance eligibility, ensuring correct coding to avoid denials, and managing payment postings and reconciliations. You will also analyze denied claims, communicate with payers to resolve issues, educate patients on their financial responsibilities, and ensure compliance with HIPAA regulations and industry standards.

For the Virtual Revenue Cycle Management (RCM) Specialist position at MedVA, a bachelor's degree in Healthcare Administration, Finance, or a related field is preferred. Additionally, having over a year of experience in RCM or medical billing is ideal. Certifications such as Certified Professional Coder (CPC), Certified Medical Reimbursement Specialist (CMRS), and Certified Revenue Cycle Representative (CRCR) are also advantageous, although not required.

As a Virtual Revenue Cycle Management (RCM) Specialist at MedVA, proficiency in EHR/EMR systems like Epic or AthenaHealth is crucial. You will need to be skilled in medical billing software and have a solid command of Microsoft Office, particularly Excel and Word. Additionally, your capability to analyze financial data will help in providing insights for more effective revenue management.

MedVA is committed to the continuous learning and development of its employees. As a Virtual Revenue Cycle Management (RCM) Specialist, you will benefit from high-quality training programs provided entirely at zero cost. We believe in empowering you with the knowledge and skills you need to excel, connecting you with industry experts throughout your training journey.

A Virtual Revenue Cycle Management (RCM) Specialist at MedVA enjoys a permanent work-from-home setup, allowing for a flexible and comfortable work environment. You can expect competitive hourly pay rates that exceed local averages, along with the benefits of working independently while also having opportunities for collaboration with other teammates and departments.

To ensure accuracy in medical coding as a Virtual RCM Specialist, it's important to stay updated on the latest coding guidelines and changes in CPT, ICD-10, and HCPCS systems. Familiarizing yourself with the documentation provided by healthcare providers and double-checking the codes against the services rendered will help minimize errors. Additionally, utilizing coding software and tools effectively can enhance accuracy.

When discussing your experience with EHR/EMR systems, focus on the specific platforms you have used, such as Epic or Kareo. Share examples of how you utilized these systems for billing and claims submission, and highlight the benefits they brought to your workflow, such as improving data accuracy and streamlining processes.

When resolving denied claims, I begin with analyzing the reason for the denial. I check the coding, verify patient eligibility, and review any documentation discrepancies. Next, I communicate with the insurance payer to gather additional information and submit a well-documented appeal, ensuring that all required details are included to support the claim's validity.

Managing time effectively in a remote work setting involves creating a structured schedule that allocates specific time slots for tasks such as billing, patient consultations, and reporting. Utilizing tools like calendars and task management software can also help stay organized. It’s crucial to set clear daily goals and prioritize tasks to maintain productivity and minimize distractions.

In my previous roles, I have taken the initiative to educate patients by providing clear and concise explanations of their financial obligations, such as copays and deductibles. I have conducted discussions during appointments and followed up through patient statements or calls to ensure comprehension, allowing them to plan their payments effectively and fostering a supportive relationship.

One of the biggest challenges in revenue cycle management is ensuring timely and correct claim submissions to prevent denials. It's essential to stay updated with ever-changing payer requirements and coding rules. This requires constant learning and adaptation to new regulations, which can be overwhelming but also offers opportunities for growth and improvement.

To stay informed about healthcare regulations and billing guidelines, I regularly read industry publications, attend webinars, and participate in relevant professional organizations. Furthermore, networking with fellow RCM specialists and engaging in online forums helps me share experiences and gather insights on upcoming changes and best practices.

Yes, there was an instance where I noticed a pattern of underpayments by a specific insurance company. I cross-referenced patient statements with the expected payments based on contracted rates. By diligently investigating, I was able to pinpoint erroneous billing codes that were being used. I communicated with the payer, corrected the issues, and ensured proper reimbursement moving forward.

During high-stress situations, such as tight deadlines for claims submissions or processing issues, I prioritize tasks based on urgency. I maintain a calm demeanor and focus on details, breaking down larger tasks into manageable steps. Additionally, I communicate with my team openly to seek assistance and share strategies for stress management, ensuring collective support and efficiency.

I am particularly attracted to the Virtual RCM Specialist position at MedVA because of the company's commitment to quality training and ongoing education. I value the opportunity to work in a remote capacity with a team that emphasizes both individual and organizational growth. My passion for revenue cycle management aligns perfectly with MedVA's mission to enhance financial processes in healthcare while supporting patient needs.