RCM Operations Support Specialist

ModMed is hiring a driven RCM Operations Support Specialist-Worker’s Comp to join our positive, passionate, and high-performing Revenue Cycle Management team focused on support of overall revenue cycle management. This is an exciting opportunity to work within a fast-paced Healthcare IT company that is truly Modernizing Medicine!

The RCM Operations Support Specialist provides support to RCM Client Success and Production teams in the day to day tasks related to efficient claim processing and overall practice revenue performance. This individual will be specifically responsible for designated functions within the system in support of overall revenue cycle management. The ideal candidate has a results-driven mindset and is a self-starter; the individual has proven success focusing on data analysis to identify and present opportunities that improve and streamline Worker’s Compensation and Auto/PIP workflows.  Must be able to perform root cause analysis and develop solutions to the root causes identified.

Your Role:

Supports overall medical billing operations and timely processing of claims, including:

• Being a Subject Matter Expert on Worker’s Compensation and Auto/PIP workflows.
• Provide knowledge and support to other RCM team members to facilitate resolving claim inquiries related to billing and Worker’s Compensation and Auto/PIP workflows.
• Reviewing and resolving Patient inquiries. 
• Conducting comprehensive performance audits of client practices to support best practices and optimal workflow for all parties. This includes:
  • Monitor billing activity
  • Assessing KPI metrics
  • Monitor payment posting activity
  • Payer and coding trend analysis
  • Meet and communicate with Client Success, RCM Coordinator and Global Partners to share best practice and recommend workflow changes  
• Specialty specific RCM support including: 
  • Monitor and support production team activity 
  • Identify and develop specialty specific best practices to help streamline RCM processes
  • Participate in team meetings 
  • Payer and coding trend analysis
  • Facilitate communication between Client Success, RCM Coordinator and Global Partners
• Developing strong relationships with adjusters and/or payers.
• Collaborating on Standard Operating Procedures (SOP) to include specific workflows and needs to ensure smooth revenue cycle.
• Collaborates with multiple BOOST departments in resolving client escalations.
• Performing additional projects and job duties as assigned

• Key Performance Measures:

  • Days Sales Outstanding (DSO): 32 days and under
  • Insurance aging over 90 days: less than 15%
  • Denials: less than 5%

Skills & Requirements:

• Bachelor’s degree preferred; Medical Billing and Coding certification preferred.
• Two plus years of related experience and/or training or equivalent combination of education and experience.
• Extensive knowledge of Workers’ Compensation payers including state nuances, laws, reports, payment rules and solutions for quick claim adjudications.
• Exceptional written, verbal and interpersonal communication skills required.
• Highly detail oriented with a critical degree of accuracy.
• Intermediate Excel skills such as the ability to use formulas to analyze data, create and formatting pivot tables and templates, use of conditional formatting and validation functions. Able to create visualizations of data through charts and graphs.
• Mastery of spreadsheets including the ability to manage information located in multiple software systems.
• Expertise in medical billing, front-office, physician practice management and healthcare business processes.
• Self-motivated; takes initiative and approaches problem solving with creativity and excitement.
• Develop expert knowledge and workflows in respective ModMed products (PM and/or gPM) within 5 months of employment.
• Strong understanding of various insurance carriers, including Medicare, private HMOs, and PPOs.
• Team player with a positive attitude, adaptable when faced with change.
• Professional demeanor required.
• Able to travel (up to 10%).

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