RCM Optimization Specialist

ModMed is hiring a driven RCM Optimization Specialist to to join our positive, passionate, and high-performing RCM team focused on driving success, retention, and new account performance for our BOOST clients. This is an exciting opportunity to help our new BOOST clients get off to the right start with a fast-paced Healthcare IT company that is truly Modernizing Medicine!

Your Role:

• Assess new client’s current workflow and consult with implementation and client advisor teams on the best approach for a successful RCM performance.
• Review configurations and practice settings prior to go live to ensure clients' live site is ready for success with our billing teams.
• Review and analyze customer accounts, identify trends and issues and implement and engage support teams for solutions.
• Monitor fee schedules and insurance denials in order to ensure fully allowed reimbursement and denial prevention strategies are implemented.
• Provide structured feedback to the Implementation team to drive continuous improvement.
• Review, document and investigate accounts where billing inaccuracies were found and guide global partners and operations support  with the necessary account/billing adjustments within the first 90 days of service delivery.
• Conduct comprehensive performance audits of client practices to support best practices and optimal outcomes for all parties. This includes:
  • Monitor billing activity
  • Assessing AR follow up
  • Monitor payment posting activity
  • Payer and trend analysis
  • Meet and communicate with client management and production team to share best practice and recommend workflow changes or enforcement of standard processes
• Ability to adapt to changing work priorities and regularly exercised independent judgment.
• Support payer configuration  activities.
• Shows ability to clearly isolate and define trends/problems, provides alternatives or solutions, participates in group problem solving discussions and prioritize work.
• Helps with auditing of new clients to access if there any issues or trends.
• Communication with global team, internal operations and client management team to get this resolved timely.
• Leverage deep knowledge and understanding of clients’ key practice revenue performance metrics to drive SLA achievements, review metrics and stabilize during ramp up accordingly. Revenue cycle performance metrics include:
  • Denials and rejection
  • Net Collection Ratio & Gross Collection Ratio
  • Charge, adjustment and payments analysis
  • Accounts receivable
• Ensure Client Key Performance Indicator benchmarks are met:
  • Days Sales Outstanding (DSO): 35 days and under
  • Insurance aging over 90 days: less than 15%
  • Denials: less than 5%

Skills & Requirements:

• Bachelors degree or equivalent experience.
• 4 years equivalent and relevant experience in RCM / process management.
• Knowledge of medical billing, front office, physician practice management and healthcare business processes and workflow.
• Understanding of medical billing/coding with an understanding of various insurance carriers, including Medicare, private HMOs and PPOs.
• Excellent written, verbal and interpersonal communication skills.
• Strong organizational skills.
• Should have knowledge and experience with financial reporting.
• Demonstrated analytical thinking and problem solving ability.  Can systematically and logically work to identify causation and resolve problems.

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