Revenue Cycle Management Specialist

RCM Operations SpecialistVaxCare is an end-to-end solution that improves immunization rates and overall vaccine program profitability. We bring ease and visibility to a complicated and fragmented system by connecting supply, management, and revenue centered around our easy-to-use digital product. We love to tackle challenges with an analytical spin. We are constantly and actively looking for ways to develop tools and solutions that help accomplish our mission of supporting physicians in providing the best care possible. Our team is passionately dedicated to maximizing RCM reimbursement opportunities with efficiency and scalability. We seek a motivated problem solver to join the Revenue Cycle Management Operations Team. This role supports three different sets of claims management responsibilities: PreProcess, Payer Outbound, Patient Inbound & Outbound. This team member plays an integral role in the claims collection cycle, providing direction and analysis on denied claims. These responsibilities help fuel our mission.Pre-Process Responsibilities:The Pre-Process Specialist role is all about the pre-submittal for claims processing. This team oversees submitting claims to Insurance companies and solving any Internal claim errors and payer rejection errors. The goal of this team is to ensure claims get to an Accepted status. This role exposes us to the use of external payer portals to obtain patient eligibility information and process the claims accurately through our clearinghouse.Payer Responsibilities:The payer team Is crucial to VaxCare as, in this role, you are working on claims that have already been denied or have an unknown status. You are contacting Insurance companies daily to get claim status and sending back claims for preprocessing If we believe Insurance companies processed them incorrectly. In this role, you must use critical thinking skills and problemsolving to overturn a denial of a paid status. The payer specialist team Is typically on the phone 60% of the time daily.Patient Responsibilities:In this role, you are responsible for making inbound and outbound contact with our patients. Our outreach to patients is to obtain additional and updated insurance information so that their claims can be processed through their insurance instead of having balance become a patient's responsibility. VaxCare's goal is not to collect money from patients unless it is dictated to their insurance company. We aim to ensure patients receive the proper care and have their insurance pay for their services. In this role, you need to be compassionate and have an understanding mindset as we deal with many patients who may be going through tough times. This role requires you to be on the 100% of the time.Required Skills:Customer Service experienceCritical thinkers, willing to research, problem solvers, high energy.Eagerness to learn the industry and position and to grow with VaxCare.Aptitude, Eagerness, and Motivated!Proficient with systems.Good tenure of consistent experienceBonus Candidates with prior Healthcare Insurance Claims experience.Responsibilities:Identify and confirm payer denial reasons using online resources to ensure they are handled appropriatelyCall healthcare insurance companies to understand denials and challenge rulings where applicableContact with patients (applicable to the Patient Specialist role)Meet daily metrics related to quality and quantity of work as assignedFile claim corrections using web-based applications and bring claims to a final state of resolution promptlyCollaborate with your team to create and implement enhanced collection techniques based on experience, data, and analyticsPrimarily, this role works with payers to understand why a claim was denied. Team members in this role also call to get the claim status, which may be paid. In that case, team members would be posting payments to our data entry portal

Created: 2025-03-03