RCM OPEX Specialist

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

Education, Experience, Skills, and Requirements