The awarded Respondent, referred to as Contractor, shall provide RCM services to WWU as described below, and in accordance with all applicable laws, including HIPAA privacy and security requirements. a. Revenue Cycle Management i. Pre-Authorization and Utilization Review: Obtaining necessary approvals for procedures and services. ii. Charge Capture and Coding: Ensuring all services provided are captured, coded appropriately and accurately billed. Identify discharged not fully billed (DNFB)/Unbilled Days claims and improve (DNFB)/Unbilled Days metric. iii. Claim Submission and Processing: Submitting insurance claims in a timely manner and following up on any denials or issues. iv. Accounts Receivable (A/R) Management: Payment processing for patient and insurance, unpaid claims tracking, credit balances, refunds, improve A/R by accelerating revenue from aged accounts. v. Denial Management: Investigating and resolving claim denials to ensure proper and timely reimbursement. b. Reconciliation and Reporting i. Work within Point and Click system. ii. Revenue Cycle Analysis: Analyzing revenue data to identify trends, patterns, and areas for improvement in the RCM process. iii. Key Performance Indicator monitoring, tracking and reporting
