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

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