Job Description
Job Summary
The RCM OPEX Specialist plays a critical role in optimizing the financial performance of healthcare organizations by ensuring that revenue cycle management processes are efficient and compliant with industry regulations. This position requires detail-oriented professionals who can navigate complex insurance claims and reimbursement processes.
Essential Job Functions
- Manage internal and external customer communications to maximize collections and reimbursements.
- Analyze revenue cycle data to identify trends and proactively remediate suboptimal processes.
- Maintain fee schedule uploads in financial and practice operating systems.
- Review and resolve escalations on denied and unpaid claims.
- Collaborate with healthcare providers, payors, and business partners to ensure revenue best practices are promoted.
- Monitor accounts receivable and expedite the recovery of outstanding payments.
- Prepare regular reports on refunds, under/over payments.
- Stay updated on changes in healthcare regulations and coding guidelines.
*NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position.
Other Essential Tasks/Responsibilities/Abilities
- Must be consistent with Femwell’s core values.
- Excellent verbal and written communication skills.
- Professional and tactful interpersonal skills with the ability to interact with a variety of personalities.
- Excellent organizational skills and attention to detail.
- Excellent time management skills with proven ability to meet deadlines and work under pressure.
- Ability to manage and prioritize multiple projects and tasks efficiently.
- Must demonstrate commitment to high professional ethical standards and a diverse workplace.
- Must have excellent listening skills.
- Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures.
- Must maintain compliance with all personnel policies and procedures.
- Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members.
- Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position.
Education, Experience, Skills, and Requirements
- Bachelor's degree preferred.
- Minimum of 2 years of experience in medical billing, coding, revenue cycle or practice management.
- Strong knowledge of healthcare regulations and insurance processes.
- Knowledgeable in change control.
- Proficiency with healthcare billing software and electronic health records (EHR).
- Knowledge of HIPAA Security preferred.
- Hybrid rotation schedule and/or onsite as needed.
- Medical coding (ICD-10, CPT, HCPCS)
- Claims management (X12)
- Revenue cycle management
- Denials management
- Insurance verification
- Data analysis
- Compliance knowledge
- Comprehensive understanding of provider reimbursement methodologies
- Billing software proficiency
Job Tags
Work at office, Local area,