Diagnosis Related Group (DRG) Coordinator jobs in Sunnyvale, CA

The Stepping Stones Group is looking for a Speech and Related RCM Specialist to join our team! This is a remote position but must be able to work on PST timezone. 

The S&R RCM Specialist is expected to perform a variety of duties working with staff throughout the agency. They are responsible for performing high-volume advanced data entry work. They should be capable of handling the different aspects of the revenue cycle including AR management and processing incoming reports. 

The job description may change from time to time and the basic duties are as follows:

Essential Job Functions and requirements include but not limited to:

• Maintain a good relationship with outside departments as well as outsource companies.
• Maintain a good relationship with insurance company contacts.
• Able to review all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes to ensure clean claims submission to insurance carriers.
• Able to troubleshoot AR issues and communicate with different levels of management.
• Navigate various systems including but not limited to EMR and clearinghouses.
• Able to review and understand insurance provider and billing manuals.
• Understand commercial and Medicaid mental health rules.
• Able to identify insurance company and complete an eligibility check.
• Able to assist in obtaining authorizations.
• Review Medicaid AR reporting and work claims until payment is obtained.
• Write claims appeals and submit corrected claims.
• Create basic billing and AR reporting in excel.

Required Qualifications:  

• Proficient computer skills, including MS Office specifically Excel.
• The ability to thrive in a fast-paced environment is essential.
• Ability to work independently, self-directed, and highly organized.
• Mental health billing experience.

Education/Certifications Required:

• High school diploma, general education degree, or equivalent.

Beneficial Experience:

• Office Ally Clearinghouse, Waystar Clearinghouse, Mental Health EMR system

Reports to:

• S&R and Mental Health Senior Manager