RCM Officer

Job Summary

The RCM officer maintains patient’s details, scans documents related to patient registration personal and insurance requirements.  S/He will secure pre-approvals for all contracted payers and assist patients with insurance coverage. S/he will submit and Adjudicate approval and claims, daily within the time and with clear justification, Patient SOB, policies, procedures, and insurance guidelines, as outlined by payer contractual agreements and according to rates as reflected in respective paper contracts.

Job Responsibilities 1

• Studies insurance plans used most frequently from patients to understand the various nuances to communicate more effectively.
• Validates patients details in the system with the scanned and uploaded patients’ documents.
• Assists Patient Access team regarding insurance requirements and co-payments/cash deductible.
• Reviews in-house patients’ documents details/approval/ claims and ascertains the quality of the claims as to:
• Accuracy of the entries/charges,
• Accuracy and completeness of approvals,
• Limits properly applied,
• Follows up on all pending approvals within 24 hours and responds to urgent requests in a timely manner.
• Submits all new Complex authorization approvals and/or Complex re -authorization approvals through the Complex audit process.
• Submits the claims with proper coding and documentation also as per the approval to avoid rejection.