RCM Operations Support Specialist AR

ModMed is hiring an RCM Operations Support Specialist, AR. The RCM Operations Support Specialist, AR, 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. The Operations Support Specialist is specifically responsible for designated functions within the system in support of overall revenue cycle management.

Your Role:

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

• Being a Subject Matter Expert on a specific speciality
• Maintenance of productivity data as needed to meet operational needs
• Provide knowledge and support to operation team members to facilitate resolving claim inquiries related to billing and payment posting
• Conduct comprehensive performance audits of client practices to support best practices and optimal workflow for all parties. This includes:
  • Assessing AR follow up
  • Ensuring SOPs are followed
  • Identifying workflow gaps
  • Payer and denial 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:
  • Identify and develop specialty specific best practices to help streamline RCM processes
  • Participate in team meetings
  • Resolving patient inquiries as it relates to AR
  • Facilitate communication between Client Success, RCM Coordinator and Global Partners
• Perform additional projects and job duties as assigned

Providing support to RCM teams achieving productivity benchmark as follows:

• Days Sales Outstanding (DSO): 35 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)
• One or more years experience ophthalmology billing
• Two plus years of related experience and/or training or equivalent combination of education and experience
• Exceptional written, verbal and interpersonal communication skills required
• Highly detail oriented with a critical degree of accuracy regarding data entry
• Basic excel skills such as the ability to perform simple calculations with formulas and functions, format spreadsheets and create visualizations of data through charts and graphs
• Knowledge of medical billing/coding, front-office, physician practice management and healthcare business processes
• Strong understanding of various insurance carriers, including Medicare, private HMOs, and PPOs
• Professional demeanor required

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