Bachelor’s degree, preferably in Business Administration, Health Administration, Finance, or a related field.
5+ years in a professional healthcare setting, preferably with RCM and/or claims processing experience
Excellent oral and written communication skills with both internal and external stakeholders
Excellent analytical, problem-solving, and decision-making skills
Microsoft Excel ninja – SQL and Python skills preferred
Detailed knowledge of healthcare claims processing, managed care network management, and revenue cycle management
Medicare billing experience strongly preferred, or knowledge of Medicare billing rules
Responsibilities:
Drive regular meetings with your assigned practices to review current pipeline activity, identify issues for resolution, and report on key metrics.
Develop subject matter expertise on the Network Providers in your book of business.
Monitor all aspects of the end-to-end reimbursement process for the accounts assigned to you, and assist staff with their work queue(s) when necessary.
Coordinate with internal teams and external Network Providers when things don’t go according to plan.
Review claims and support data to measure SLA and contract compliance, and report on trends and opportunities for improvement to your practices, your team, and senior leadership.