RCM Contract Support Specialist

Job Summary

Lead and deliver projects related to the development and configuration of new business, insurance contracts, provider contracts, new pricing and editing. Manage the enhancements, compliance and system enhancements. Ensure that ongoing activities are performed according to established policies and procedures as well as applicable state regulations and specific contractual provisions.

Key Duties / Responsibilities / Accountabilities

• Interpret insurance contract pricing tables as well as additional business requirements.
• Translate standard business requirements into functional requirements, specified to an appropriate level of detail.
• Collaborate with system vendors, IT, and integration teams to troubleshoot configuration limitations, defects, and enhancements.
• Absess financial impact of configuration decisions and errors, ensuring alignment with revenue integrity and compliance requirements.
• Follow procedures to manage major system configuration projects, including claims business rule set up outlier management.
• Monitor payer, regulatory, and coding updates to proactively adjust system configuration as requirements evolve.
• Perform quality review of completed configuration, assess outcomes and manage remediation of any noted discrepancies.
• Support the billing team and related business areas.
• Create help sheets and training materials for functional areas.
• Review data post system implementation to ensure accuracy of configuration.
• Share accountability for realization of results with process owners and assist in presentation of recommendations to stakeholders.
• Identify and analyze trends by researching and responding to claims configuration requests, problem reports, and inquiries.
• Identify areas of improvement in existing work processes, and provide recommendations.
• Monitor configuration-driven performance metrics such as denial rates, AR aging, and underpayments to evaluate effectiveness of system rules.

Benefits

• Competitive compensation package including medical, vision, dental, short- and long-term insurance
• 6+ Days of Holidays
• 17 days of PTO
• Employer paid life insurance
• 401K with employer contribution
• Wellness program with reward incentives
• Employee recognition and reward programs
• Comprehensive paid training program