RCM Preprocessing Specialist I
ProPath

Job Info

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ProPath, the largest 100% physician-owned, nationwide pathology practice, seeks an exceptional RCM Preprocessing Specialist I to join our thriving practice. The selected individual will become a part of a 50+ physician group and independent laboratory. ProPath is a nationally recognized practice founded in 1966 and based in Dallas and facilities in Houston, Atlanta and Massachusetts. We have over 50 physicians and PhD’s on the team. Our over 500 team members are based in 11 different states with physical facilities in three.

This position is responsible for prior authorization, eligibility and bad address processes.   Duties focus on ensuring testing that requires prior authorization from the payer is obtained, bad address/returned mail is researched and processed, and all eligibility rejections/denials are properly updated.  Duties also include assisting with preprocessing errors in the billing system.  This position is critical to ensure accurate payer information and patient demographics for timely billing and collections.

PRINCIPAL DUTIES: 

• Coordinate prior authorization process with vendor to ensure billing system is updated for claim to file with the required information to payer.
• Research returned mail for claims address to correct accordingly and update configurations
• Process Bad Address accounts to ensure proper delivery of patient statements.
• Accurately process and update eligibility information on patient accounts to facilitate claim to correct payer.
• Research and resolve missing or invalid data related to charges and/or claims, such as patient demographics, payer ineligibility, inactive payers, etc.
• Research and resolve transactional errors such as mismatch financial class, service date questionable, CCI/MUE, etc,
• Research unbilled charges to ensure filing deadlines are met.
• Identify and/or resolve pre-processing system errors and claim edits requiring system configuration changes or functionality updates.
• Assist with creating/updating mapping of data from internal and external sources to ensure billing related data is accurate and consistently maintained.
• Communicate with manager consistent staff errors requiring additional work.
• Assist Billing System Administrators with mapping projects as needed.
• Meet and/or exceed productivity and quality goals set by management.
• Maintain confidentiality of employee, patient, client, and company records/issues.
• Maintain familiarity with negotiated contracts.

EDUCATION/KNOWLEDGE:

High School diploma or equivalent.  Some college helpful.  Ability to effectively communicate orally and in writing with co-workers and management personnel. Must have ability to problem solve and pay attention to detail.  The ability to work independently.  General knowledge of CPT/HCPCS codes, general coding guidelines, claims processing, and Medicare requirements specifically related to pathology/laboratory. Familiarity with Microsoft software including Excel, Word, and Outlook. 

EXPERIENCE:

Minimum of 1-3 years of experience in medical billing claims processing.  Prior experience with prior authorizations and front-end billing systems desired.

ProPath offers employees a full benefits package that includes: medical, dental, a matched 401K plan, and much more! EOE/M/F/D/V/SO

Don’t Follow the Leader, Join the Leader!

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