The RCM Floater is responsible for assisting the BVS Specialist, Rx Specialist, and RCM Team in verifying patient benefits, obtaining updated Rx for patient care, and assisting the Auth and Billing Teams in billing insurance companies and requesting prior authorizations and other duties as required by Management Team.
- Assist BVS Specialist in obtaining patient benefits and coordinating with Therapy and PC Teams.
- Assist Rx Specialist in requesting updated Rx for patient care and updating patient charts.
- Assist Authorizations Team in requesting prior authorizations and coordinating with Therapy and PC Teams.
- Assist Billing Team in billing insurance companies and ensuring proper processing of claims.
- Review ledger activity for proper payments and adjust as needed.
- Obtain patient benefits and update patient charts as needed. Coordinate with Therapy and PC Teams.
- Contact Physician offices to obtain updated Rx as needed. Update charts as needed and follow tracking system for expiring Rx.
- Contact Insurance companies to obtain prior authorizations as needed to assist Authorizations Team.
- Review billing activity on accounts and ensure proper processing of claims by insurance companies on accounts over 180 days aged.
- Answer incoming calls and communicate with insurance companies and patient guarantors to resolve billing issues and answer questions.
- Audit Ledger activity and Aging for outstanding unbilled claims and unpaid claims over 180 days aged.
- Audit patient setups for appointments without authorizations.
- Audit patient charts for missing or expired Rx.
- Audit patient accounts for missing authorizations.
- Audit patient accounts for appropriate referring and rendering providers, i.e. Medicaid accounts have an Rx from a Medicaid certified provider.
- Audit patient accounts for appropriate financial agreement status. Update accounts with new financial agreements as needed.
- Audit Eligibility Check report twice monthly.
- Other duties as assigned by Management Team.