Senior Revenue Cycle Management (RCM) Specialist- Work From Home

ClinicMind is a leading provider of comprehensive healthcare practice management software and service platform for a full patient care cycle. We are seeking a highly experienced and results-driven Senior Revenue Cycle Management (RCM) Specialist to lead and manage our RCM teams. The ideal candidate will excel in overseeing the resolution of insurance claim backlogs, optimizing processes, and driving key performance indicators (KPIs) to ensure the highest standards of operational excellence. This role is integral to achieving a seamless, efficient revenue cycle and ensuring our clients' financial health.

Key Responsibilities:

1. • Team Leadership & Management

   • Lead, mentor, and manage the teams responsible for addressing RCM insurance claim backlogs, including claims specialists and billing analysts.

   • Foster a culture of accountability, efficiency, and continuous improvement.

   • Conduct regular performance evaluations and implement training initiatives to enhance team skills.

   • Operational Excellence in Claims Management

   • Drive the resolution of Active Failed claims to zero daily by implementing effective prioritization and workflows.

   • Ensure Total Failed claims remain at minimum levels, leveraging analytics and proactive interventions.

   • Oversee the resolution of aged claims, maintaining Accounts Receivable >120 days at or below 5%.

   • Process Improvement & Quality Assurance

   • Identify root causes for claim errors and develop corrective actions to maintain claim error rates at below 1%.

   • Monitor and improve processes to achieve and sustain a Net Collection Rate (NCR) of 97% or higher.

   • Develop and implement policies, procedures, and best practices for claims processing and denial management.

   • Data-Driven Decision Making

   • Utilize RCM software and data analytics tools to track and report on KPIs, trends, and team performance.

   • Collaborate with cross-functional teams to identify areas for improvement and execute data-informed strategies.

   • Stakeholder Engagement

   • Serve as a primary point of contact for escalations related to claim processing and insurance reimbursements.

   • Communicate regularly with internal and external stakeholders to ensure alignment on objectives and expectations.

   Qualifications:

   • Bachelor’s degree in healthcare administration, business administration, or a related field. Master’s degree preferred.

   • Minimum of 8 years of experience in revenue cycle management, with a proven track record in managing insurance claims, backlogs, and denials.

   • Extensive knowledge of healthcare billing, coding, and reimbursement processes.

   • Strong leadership and team management skills, with experience managing large, diverse teams.

   • Proficiency in RCM software, data analytics tools, and advanced Excel functions.

   • Exceptional problem-solving skills and attention to detail.

   • Outstanding communication and organizational skills, with the ability to manage multiple priorities effectively.

   Key Performance Indicators (KPIs):

   • Active Failed claims resolved daily (target: 0)

   • Total Failed claims kept at a minimum

   • A/R >120 days maintained at or below 5%

   • Claim error rates maintained below 1%

   • Net Collection Rate (NCR) sustained at 97% or higher

   Position Requirements

   • Must have a stable internet connection minimum of 5 MBPS

   • Must have a mobile data plan as a backup

   • Must be in a quiet environment

   • Must be comfortable working the US business hours

   • Must own a PC with at least 16 GB of memory