RCM Contract Support Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee and execute projects pertaining to the development and configuration of new business, insurance contracts, provider agreements, new pricing structures, and revisions.

• Manage enhancements, compliance matters, and system upgrades.

• Ensure that ongoing operations adhere to established policies, procedures, state regulations, and contractual obligations.

• Collaborate with system vendors, IT, and integration teams to address configuration limitations, defects, and enhancements.

• Evaluate the financial implications of configuration decisions and errors.

• Lead significant system configuration projects, including the setup of claims business rules and outlier management.

• Keep track of payer, regulatory, and coding updates, adjusting system configurations proactively.

• Conduct quality reviews of completed configurations and manage the remediation of any discrepancies.

• Work with billing management to resolve claim issues and implement corrections.

• Provide support to the billing team and associated business areas.

• Develop help sheets and training materials.

• Review data following system implementation to confirm configuration accuracy.

• Assist process owners and stakeholders with recommendations and presentations of results.

• Identify and analyze trends from claims configuration requests, problem reports, and inquiries.

• Suggest improvements to existing work processes.

• Monitor configuration-driven metrics such as denial rates, accounts receivable aging, and underpayments.

⛳️ Requirements

• Capability to interpret insurance contract pricing tables and additional business requirements.

• Ability to translate standard business requirements into detailed functional specifications.

• Proficient in collaborating with system vendors, IT, and integration teams.

• Understanding of revenue integrity and compliance requirements.

• Experience managing major system configuration projects, including claims business rule setup and outlier management.

• Ability to monitor payer, regulatory, and coding updates.

• Skill in performing quality reviews of completed configurations and addressing discrepancies.

• Competence in resolving claim issues resulting from system configurations.

• Ability to create help sheets and training materials.

• Experience reviewing post-implementation data to ensure configuration accuracy.

• Proficiency in analyzing claims configuration requests, problem reports, and inquiries.

• Ability to monitor denial rates, accounts receivable aging, and underpayments.

• Team-oriented; works effectively as part of a group.

• Self-motivated and capable of working independently.

🏝️ Benefits

• Medical, Vision, Dental, Short- and Long-term insurance.

• 6+ Days of Paid Holidays.

• 17 days of Paid Time Off (PTO).

• Employer-paid life insurance.

• 401K plan with employer contributions.

• Wellness program with reward incentives.

• Employee recognition and reward programs.

• Comprehensive paid training program.