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RCM OPEX Specialist
RCM OPEX SpecialistFemwell Group Health • Miami, FL, United States
RCM OPEX Specialist

RCM OPEX Specialist

Femwell Group Health • Miami, FL, United States
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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
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    Rcm Specialist • Miami, FL, United States

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