RCM Associate, Member AR, Pre-Access – Contractor

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

📋 Description

• Ensure timely and precise financial clearance and submission of claims.

• Investigate and address inquiries regarding authorization, referrals, eligibility, and member billing.

• Assess and resolve issues related to authorization, referral, and eligibility while achieving productivity and quality benchmarks.

• Acquire knowledge of payer-specific requirements, including authorizations, referrals, carve-outs, and TPA plans.

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

• Calculate the financial responsibilities of members and provide accurate cost estimates.

• Review billing activities and transaction histories to address member billing inquiries.

• Log and reconcile member payments within the practice system.

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

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

• Maintain precise member records in the electronic medical record and billing systems.

• Generate reports and analyze balance and authorization data to identify trends and communicate findings.

• Highlight workflow challenges and propose enhancements.

• Assist in the rollout of workflows and uphold standard operating procedure documentation.

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

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

• Adhere to HIPAA compliance guidelines and pertinent regulations.

⛳️ Requirements

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

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

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

• Familiarity with billing, coding, and claims follow-up processes.

• Experience in liaising with payers to resolve issues.

• Proficient in Excel and comfortable with basic data analysis.

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

• Ability to navigate multiple systems and workflows effectively.

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

• Excellent communication and interpersonal skills.

• Self-motivated individual who seeks answers and learns rapidly.

• Commitment to advocating for Headspace’s members.

• All hires must demonstrate at least Level 1 AI proficiency.

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

• Preferred: Background in B2B2C healthcare.

• Preferred: Exposure to health plans or Employee Assistance Programs (EAP).

🏝️ Benefits

• Sword provides additional benefits beyond total compensation; specific benefits may vary by country and will be outlined separately.