RCM Operations Specialist

About the role

VaxCare is a healthcare system aiming to streamline complexity by providing efficient and scalable revenue cycle management solutions. This role is essential for supporting three sets of claims management responsibilities: PreProcess, Payer Outbound, Patient Inbound & Outbound.

Responsibilities

• Identify and confirm payer denial reasons using online resources to ensure appropriate handling.
• Call healthcare insurance companies to understand denials and challenge rulings where applicable.
• Contact with patients (applicable to the Patient Specialist role) to obtain additional and updated insurance information.
• 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 work with payers to understand why a claim was denied. In cases where the claim is paid, post payments to our data entry portal.

Qualifications

• 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.

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 have 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.