RCM Associate, Member AR, Pre-Access – Contractor

This is a fully remote position, open to applicants in United States.

📋 Description

• Facilitate prompt and precise financial clearance along with claims submission.

• Investigate and resolve inquiries related to authorization, referrals, eligibility, and member billing.

• Examine and address issues concerning authorization, referrals, and eligibility while achieving productivity and quality goals.

• Acquire and implement payer-specific protocols, including authorizations, referrals, carve-outs, and TPA plans.

• Engage with members to gather financial details and confirm insurance coverage.

• Assess member financial obligations and deliver precise cost estimates.

• Analyze billing activities and transaction histories to respond to member billing inquiries.

• Document and reconcile member payments in the practice management system.

• Identify opportunities for collections, such as payment plans and hardship applications, and escalate as necessary.

• Collaborate with coding, clinical, and Member Support teams regarding billing inquiries.

• Ensure accurate maintenance of member records in electronic medical records and billing systems.

• Generate reports and examine balance and authorization data to uncover trends and communicate findings.

• Highlight workflow challenges and propose enhancements.

• Assist with workflow implementations and maintain standard operating procedure documentation.

• Collaborate with colleagues and occasionally engage with Product / Engineering teams to address RCM issues.

• Elevate complex or unresolved matters to the team lead or manager.

• Adhere to HIPAA compliance standards and relevant regulations.

⛳️ Requirements

• A minimum of 3 years in Revenue Cycle Management, with a solid understanding of medical billing claims.

• Knowledge of financial clearance, insurance verification, or authorizations.

• Experience in direct communication with members or patients regarding billing or insurance matters.

• Proficient understanding of billing, coding, and claims follow-up processes.

• Experience in liaising with payers to resolve issues.

• Proficiency in Excel and comfort with basic data analysis tasks.

• Familiarity with claims billing software and Microsoft Office, along with a willingness to learn new tools.

• Capability to navigate through multiple systems and workflows.

• Exceptional attention to detail and strong problem-solving abilities.

• Excellent communication and interpersonal skills.

• Self-motivated individual who inquires and learns rapidly.

• Dedication to advocating for Headspace’s members.

• Every hire must demonstrate at least Level 1 AI proficiency.

• Preferred: Background in behavioral health, mental health, telehealth, or digital health billing.

• Preferred: Experience in B2B2C healthcare.

• Preferred: Familiarity with health plans / EAP.

🏝️ Benefits

• Sword offers additional benefits beyond total compensation; country-specific benefits may vary and will be detailed separately.