In this role, you will leverage your deep understanding of healthcare revenue cycle management (RCM) to ensure efficient and accurate accounts receivable (AR) processes for our clients. You will be the go-to resource for complex AR issues, providing guidance and support to our team and clients. The RCM Subject Matter Expert (SME) will provide specialized knowledge and expertise in revenue cycle management to support our organization’s financial and operational goals. This role involves analyzing, designing, and implementing effective RCM strategies, as well as serving as a key resource for resolving complex issues and providing training to staff.
The ideal candidate will have extensive experience in healthcare revenue cycle processes and a proven track record of optimizing financial performance.
● Proven expertise in all aspects of the healthcare AR process, including insurance billing,
coding, claims submission, denials management, and collections.
● Strong understanding of healthcare coding systems (ICD-10, CPT).
● In-depth knowledge of healthcare insurance regulations and payer requirements.
● Excellent analytical and problem-solving skills.
● Exceptional written and verbal communication skills.
● Ability to work independently and as part of a team.
● Proficient in Microsoft Office Excel or Google Sheets.
Key Responsibilities:
● Expertise & Consultation:
○ Serve as the primary point of contact for all matters related to revenue cycle
management.
○ Provide expert advice and recommendations on RCM best practices, policies, and
procedures.
○ Analyze current revenue cycle processes and identify opportunities for improvement.
● Process Optimization:
○ Contribute to the AR workload and process claims while analyzing best ways to
reduce denials and maximize revenues.
○ Develop and implement strategies to enhance billing, coding, collections, and
accounts receivable processes.
○ Work with cross-functional teams to streamline workflows and eliminate
inefficiencies.
○ Conduct root cause analysis on denials and implement corrective actions to reduce
denials and improve collections.
● Training & Development:
○ Develop and deliver training programs for staff on RCM processes, compliance, and
new technologies.
○ Mentor and support revenue cycle staff to build their expertise and improve
performance.
○ Stay current with industry trends and changes in regulations to ensure the
organization’s compliance and competitive edge.
● Performance Monitoring & Reporting:
○ Monitor key performance indicators (KPIs) related to the revenue cycle and prepare
detailed reports for senior management.
○ Provide actionable insights based on data analysis to drive strategic decisions.
○ Track the effectiveness of implemented strategies and make adjustments as needed.
● Compliance & Quality Assurance:
○ Ensure adherence to all federal, state, and local regulations related to healthcare
billing and coding.
○ Maintain up-to-date knowledge of industry standards, coding guidelines, and
regulatory requirements.
○ Implement quality assurance measures to ensure accuracy and compliance in all
RCM processes.
● Technology & Innovation:
○ Evaluate and recommend new technologies and software solutions to enhance RCM
operations.
○ Lead the implementation of new systems and tools, ensuring smooth integration and
user adoption.
○ Continuously seek innovative solutios to improve revenue cycle efficiency and effectiveness.
