RCM Specialist

Position Overview

We're seeking a Revenue Cycle Management (RCM) Specialist who can blend technical prowess with expertise in revenue cycle management, market dynamics, Zelis products, and medical coding.

Your primary goal will be to conduct thorough analyses demonstrating how Zelis products align with and advance our clients' objectives.

In this position, you'll dive deep into understanding the data landscape, determining which data sets address end-users' inquiries, and articulating how data discrepancies impact overall outcomes.

Crafting templated presentations and narrative-driven data stories to clarify results and challenges will also be part of your routine.

Additionally, you'll be expected to grasp the intricacies of each product's processes, pinpoint any inefficiencies, and collaborate with team members to ensure all outcomes meet production standards.

Working closely with Sales, Account Management, and supporting teams, you'll play a pivotal role in identifying and seizing new business opportunities, as well as facilitating upselling endeavors.

Key Responsibilities

Become knowledgeable about all Zelis product offerings supported within the role

Work with urgency to complete projects within or prior to SLAs / TATs

Work independently to upload, map, and align data sets to company processes

Understand and interpret business needs and / or expectations of clients and / or stakeholders to produce data driven solutions that correlate to Zelis Production outputs

Present results of quality control reviewed data analytics

Prepare and speak to SQL inquiries related to data from any stakeholder

Troubleshoot, validate, and update data analytics

Prioritize multiple projects and collaborate with team members and business / technical partners as needed for support and business needs

Continuously identify opportunities to create / develop reporting, visualization tools, and processes to drive efficiency, accurate results, and compelling data stories

Required Qualifications

2+ years of data analysis experience with large datasets

2+ years of medical revenue cycle management experience; this can include experience in billing, denials management, auditing, consulting, edit configuration, edit building, and negotiations

2+ years of experience with medical coding; multispecialty experience

Preferred Qualifications

Ability to prioritize multiple ongoing projects and responsibilities

Deep medical billing and revenue cycle management industry knowledge

CPC or RHIA certifications may be beneficial

Familiarity with SQL and database table structures, or corresponding data mining experience

Capacity for critical and strategic thinking

Proficient in use of Excel, including advanced excel formulas, pivot table use and data aggregation

Experience in utilizing ticketing systems and data analysis platforms