Revenue Cycle Management Specialist

About the Job:

The RCM Operations Specialist is responsible for ensuring that all payer configurations are accurately established in the system and that any billing issues related to payer contracts, claims submission, and payment processes are promptly resolved. This role ensures that the organization is properly set up to receive reimbursements from all payers, including commercial insurers, Medicare, Medicaid, and other third-party payers. The role also involves working closely with the billing and coding teams to correct any billing errors and ensure seamless claim processing.

What Youll Do:

1. Payer Setup and Configuration: Accurately set up and maintain payer information within the RCM system, ensuring all insurance contracts and fee schedules are correctly entered
2. Portal Setup: Ability to set up payer portals and provide privileges to the right teams
3. Contract Management: Ensure that payer contracts are correctly reflected in the billing system, including payment terms, coding rules, and reimbursement rates
4. Billing Issue Resolution: Identify and resolve any issues related to payer billing setup, provider credentialing, coding, claims rejections, underpayments, or denials due to payer configuration errors
5. Denial and Rejection Follow-Up: Work with denial management teams to address rejected claims related to payer configuration, and correct errors that prevent claims from being processed

What Youll Bring:

• 2+ years of healthcare experience required
• Great time management and prioritization skills, ability to juggle multiple referrals at once
• Experience utilizing Electronic Health Records (EHR) systems
• Experience using insurance portals (Availity, Medicare, CoverMyMeds, Optum, etc)
• Experience doing benefit verification and submitting authorizations
• Detail oriented in documentation
• Excellent communication skills (written and verbal)
• Medical terminology experience

What we have to offer:

• A company culture based on our purpose to bring out the untapped potential, creativity, and success in people, partnerships, and brands.
• A culture built on the mission to develop high-functioning teams by providing an environment of constructive support and inspiration where people grow personally and professionally
• A market competitive total compensation/rewards package including:

• • Day 1 HMO
  • Competitive pay including incentives and generous allowances
  • Payment of all statutory government benefits
  • 25 days of annual paid leave some days are convertible to cash
  • 13^th month pay
  • Onsite medical support
  • Employee Engagement Events
  • Employee Referral Program
  • Skills, training for personal and professional development

A million possibilities are waiting to be ignited. Click "Apply Now"!