JOB SUMMARY
Responsible to know and facilitate specific accounts and their unique attributes in order to successfully provide 
customized RCM for each account. This is a dual position with its own workload along with oversight to train, 
audit and monitor the group for accurate procedures and turnaround. Ensure workflow, including collecting 
payments stays current and on track with regards to insurance carriers, patients, clients and internal 
interactions. Supports the overall
Operations and Client Services by efficiently and effectively providing and reviewing account data needed for the 
Revenue Cycle process and delivering results.

ESSENTIAL FUNCTIONS/MAJOR JOB RESPONSIBILITIES
• Strong customer service skills for client satisfaction, health of client AR and guidance for RCM team 
members
• Answers client calls; prompt return and follow up to all interactions; prompt response to requests for 
information, both internally and externally.
• Acts as initial point person for team regarding technical work questions/processes/procedures to provide 
training/guidance. 
• Escalates issues to RCM Management related to clients and staff. 
• Trains individuals on systems and workflow in order to ensure protocols are followed.
• Reviews and works all unpaid and denied insurance correspondence, both phone appeals and written 
appeals; confirm all patient demographics and insurance is current and up to date.
• Runs, reviews and works unpaid patient balance reports for payment by reading current notes and place for 
past due letters and phone calls.
• Prepares insurance/patient correspondence for coworkers by reviewing and batching for further attention 
and review.
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• Prepares and sends uncollected patient payments to collections by writing up forms for the doctors to 
review.
• Reviews and works insurance and patient over payments, prepare refund request and send to doctor's 
office.
• Answers phone calls from insurances and patients.
• Organizes, identifies and improves workflow with team members/Management through daily and weekly 
productivity reports and reports challenges and concerns and requests need for assistance to RCM 
Management.
• Ability to perform the duties of the Payment Entry Specialist, Charge Entry Specialist, AR Specialist and 
RCM Specialist roles.
• Keeps manager informed of progress, achievements and issues; assist staff with processes, information 
and workload.
• Achieve goals set by management and compliance requirements.
• Follows, and models adherence to all policies, procedures and processes.
• Other duties as assigned.

Knowledge, Skills and Abilities
• Knowledgeable of CPT and ICD coding and medical terminology
• Extensive knowledge with email, search engines, Internet, ability to effectively use payer websites and 
Laserfiche; basic competence in use of Microsoft products.
• Preferred experience with MS Access and PowerPoint, Crystal reports and various billing systems, such 
as NextGen, Pro, Allscripts, Epic and others
• Knowledge of CPT, ICD10 and modifiers.
• Experience in specialities such as Psychiatry, Internal Medicine, Orthopaedics, General Surgery
• Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers
• Strong communication skills

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish. 

• Quarterly Company-Wide Recharge Days

• Peer-based incentive “Cheer” awards

• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/ 

https://veradigm.com/about-veradigm/careers/culture/ 

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Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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