What are the responsibilities and job description for the RCM Operations Specialist position at VaxCare?
ABOUT VAXCARE
VaxCare is an end-to-end solution that improves immunization rates and overall vaccine program profitability. We bring ease and visibility to a complicated and fragmented system by connecting supply, management, and revenue centered around our easy-to-use digital product. We love to tackle challenges with an analytical spin. We are constantly and actively looking for ways to develop tools and solutions that help accomplish our mission of supporting physicians in providing the best care possible.
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.
QUALITIES DESIRED
- Customer Service experience
- Critical thinkers, willing to research, problem solvers, high energy.
- Eagerness to learn the industry and position and to grow with VaxCare.
- Aptitude, Eagerness, and Motivated!
- Proficient with systems.
- Good tenure of consistent experience
- *Bonus* Candidates with prior Healthcare Insurance Claims experience.
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
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.
