RCM Operations Specialist

ABOUT VAXCARE

The healthcare system is complex, presenting challenges for everyone-patients, doctors, nurses, office managers, and billers alike. At VaxCare, we aim to streamline this complexity, eliminating unnecessary costs and confusion so that practices can focus on their important work: caring for patients. Our innovative solutions include a vaccine management and LARC access platform trusted by over 20,000 active providers nationwide. This service is powered by a multidisciplinary team of dedicated professionals who lead with integrity and a relentless drive to exceed expectations, bringing clarity and efficiency to the often-overwhelming world of healthcare.

THE POSITIONS

Our team is passionately dedicated to maximizing RCM reimbursement opportunities with efficiency and scalability. We seek a motivated problem solver to join the Revenue Cycle Management Operations Team. This role supports three different sets of claims management responsibilities: PreProcess, Payer Outbound, Patient Inbound & Outbound. This team member plays an integral role in the claims collection cycle, providing direction and analysis on denied claims. These responsibilities help fuel our mission.

PreProcess Responsibilities:

The PreProcess Specialist role is all about the pre-submittal for claims processing. This team oversees submitting claims to Insurance companies and solving any Internal claim errors and payer rejection errors. The goal of this team is to ensure claims get to an Accepted status. This role exposes us to the use of external payer portals to obtain patient eligibility information and process the claims accurately through our clearinghouse.

Payer Responsibilities:

The payer team Is crucial to VaxCare as, in this role, you are working on claims that have already been denied or have an unknown status. You are contacting Insurance companies daily to get claim status and sending back claims for preprocessing If we believe Insurance companies processed them incorrectly. In this role, you must use critical thinking skills and problem-solving to overturn a denial of a paid status. The payer specialist team Is typically on the phone 60% of the time daily.

Patient Responsibilities:

In this role, you are responsible for making inbound and outbound contact with our patients. Our outreach to patients is to obtain additional and updated insurance information so that their claims can be processed through their insurance instead of having balance become a patient's responsibility. VaxCare's goal is not to collect money from patients unless it is dictated to their insurance company. We aim to ensure patients receive the proper care and have their insurance pay for their services. In this role, you need to be compassionate and have an understanding mindset as we deal with many patients who may be going through tough times. This role requires you to be on the 100% of the time.

ESSENTIAL RESPONSIBILITIES

• Identify and confirm payer denial reasons using online resources to ensure they are handled appropriately
• Call healthcare insurance companies to understand denials and challenge rulings where applicable
• Contact with patients (applicable to the Patient Specialist role)
• Meet daily metrics related to quality and quantity of work as assigned
• File claim corrections using web-based applications and bring claims to a final state of resolution promptly
• Collaborate with your team to create and implement enhanced collection techniques based on experience, data, and analytics
• Primarily, this role works with payers to understand why a claim was denied. Team members in this role also call to get the claim status, which may be paid. In that case, team members would be posting payments to our data entry portal

REQUIRED QUALITIES & EXPERIENCE

• Proven Customer Service Skills: Demonstrated ability to provide exceptional support, ensuring a positive and efficient customer experience.
• Analytical & Resourceful Thinkers: Naturally curious problem-solvers who research solutions, think critically, and bring high energy to challenges.
• Eager Learners: Motivated to understand the industry, master the role, and grow within VaxCare.
• Proactive & Driven: Self-starters who take initiative, show enthusiasm, and stay focused on results.
• Technologically Proficient: Comfortable navigating multiple systems, platforms, and software tools with accuracy and efficiency.
• Reliable Tenure: Consistent, stable work history that demonstrates commitment and dependability.
• Preferred: Candidates with prior experience in Healthcare Insurance Claims or related healthcare administration a plus.

ESSENTIAL RESPONSIBILITIES

• Investigate and resolve claim denials by identifying root causes using online resources and payer portals to ensure timely and accurate handling.
• Communicate with healthcare insurance companies to clarify denial reasons, challenge rulings when appropriate, and secure claim resolutions.
• Engage with patients (for applicable roles such as Patient Specialist) to gather information, provide updates, and ensure a positive service experience.
• Meet established performance goals related to quality, accuracy, and productivity.
• Submit claim corrections and adjustments through web-based applications, ensuring all updates are accurately documented and processed to completion.
• Collaborate with team members to enhance collection workflows through data-driven insights, analytics, and continuous process improvement.
• Work with payers to validate claim outcomes, confirming when claims are approved or paid, and posting corresponding payments within the data entry system.

CORE COMPETENCIES: Core to all positions at VaxCare

• We Live (and Work) by Our Values:
  • "VaxCare-ness" (Art of Care) - Nurturing and providing for each team member
  • Belief in Something Bigger than Ourselves - Capacity to derive meaning from a larger purpose
  • Humility as a Posture of Learning - Burning curiosity to learn without ego
  • Adaptability & Embracing Change - Nimbleness & ready to seize new opportunities
• Additional "Must Haves":
  • Dependability - Must be able to meet deadlines, work independently, maintain focus, be punctual and good attendance record.
  • Interpersonal Skills - Builds strong relationships & contributes to a positive work environment.
  • Computer Skills - Skilled with computers, learns new tools quickly.
  • Ethics - Honest, accountable, maintains confidentiality.

Note: Team Members in this position will be responsible for implementing and acting in accordance with VaxCare's information security policies; protecting assets from unauthorized access, disclosure, modification, destruction or interference; executing specific security processes or activities as assigned by the Information Security and/ or Privacy officers; and reporting security events or potential security risks to the organization.

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