RCM Specialist (Part Time)

Primary Purpose
Oversees pre-date of service revenue cycle and medical billing functions for the Universitys two locations in San Francisco and Sacramento. Responsibilities include scheduling coordination registration insurance eligibility and benefits verification payer participation credentialing authorizations patient financial estimates and collection of expected out-of-pocket amounts. Maintains a current payer matrix and applicable fee schedules and ensures patient responsibility is accurately identified. Coordinates with the outsourced billing/ RCM vendor and monitors claims A/R denials timely-filing risks unworked claims payments and collections to ensure issues are identified and resolved. Serves as the primary liaison between the University providers patients and the outsourced billing team. The position is ideally based in San Francisco and requires regular travel to Sacramento; as volume grows the position may hire and manage additional billing staff.

Essential Functions
Business Administration Coordinates surgery scheduling and registration processes and verifies that required insurance and patient information is complete before the date of service. Resolves patient financial questions and conflicts professionally including explaining estimates copays coinsurance deductibles and separate professional and facility financial responsibility. Manages the relationship with the outsourced billing/ RCM vendor; conducts regular RCM reviews and monitors claims A/R denials timely filing unworked claims payments and collection performance. Oversee pre-date of service patient collections and ensures collected amounts are accurately documented and communicated to the appropriate billing/finance team. Oversee physician credentialing payer enrollment/participation and maintenance of credentialing files and payer documentation. Coordinates scheduling and directs duties of business office staff as applicable. As volume grows may recruit hire train and manage additional billing staff. Monitors outsourced A/R and collections performance including aging denials timely-filing risks unworked claims payments and collectible A/R; escalates revenue leakage and unresolved issues. Professional Development Develops relationships with billing organizations ASC state and local associations and dental billing organizations to remain current on industry guidelines payer requirements and revenue cycle best practices. Attends at least one relevant industry conference association meeting or educational program annually to maintain current knowledge of ASC dental and revenue cycle trends Activities that Enhance the Image of the Facility May participate in activities that promote a healthy community. Demonstrates knowledge and professionalism with community and other organizational members. Provides timely response and resolution to client complaints. Communication Listens respectfully gives feedback directly honestly and talks with others to clarify differences. Effectively communicates and interacts with patients (using translation services when needed) their family and other external and internal clients (including fellow employees) from diverse backgrounds. Quality Demonstrates a willingness to look at new ideas and work in a changing environment. Understands verbalizes and participates in the quality improvement process. Supports initiatives designed to improve individual and organizational performance. Other duties as assigned. University of the Pacific recognizes that diversity equity and inclusion is foundational to the success of our valued students and employees. We prioritize policy and decision-making that demonstrates awareness of and responsiveness to the ways socio-cultural forces related to race gender ability sexuality socio-economic status etc. impede or propel students faculty and staff.

Minimum Qualifications
High school diploma or GED . Three (3) or more years of healthcare revenue cycle experience preferably in an ASC dental/oral surgery or surgical setting. Experience with insurance verification benefits investigation prior authorization credentialing patient financial counseling and healthcare collections.

Preferred Qualifications
ASC billing experience. Dental or oral surgery revenue cycle experience; experience working with both professional and facility billing is preferred. Able to read write and communicate effectively with co-workers and patients. Flexible. Able to take directions from multiple sources. Displays a primary interest in serving the needs of the customer and maintaining standards of courtesy and friendliness to co-workers. Able to work independently manage multiple priorities and travel between the San Francisco and Sacramento locations as needed. Detail oriented and willing to flex hours to meet facility needs. Knowledge of insurance eligibility and benefits payer requirements prior authorization credentialing patient financial responsibility and healthcare collections. Understanding of professional versus facility billing and common ASC revenue-cycle processes. Proficiency with Microsoft Office Suite and web-based payer portals. Knowledge of basic medical/dental terminology and strong attention to detail. Machines Equipment Work Aides: Computer Microsoft Office Suite copier phones and shredder.

Work Schedule
Work typically performed during standard business hours in person. Subject to busy clinical business environment requiring above average ability to prioritize and organize. Some overtime may be required.