RCM OPEX Specialist

Job Summary The RCM OPEX Specialist plays a critical role in optimizing the financial performance of healthcare organizations by ensuring that revenue cycle management processes are efficient and compliant with industry regulations. This position requires detail-oriented professionals who can navigate complex insurance claims and reimbursement processes.Essential Job FunctionsManage internal and external customer communications to maximize collections and reimbursements.Analyze revenue cycle data to identify trends and proactively remediate suboptimal processes.Maintain fee schedule uploads in financial and practice operating systems.Review and resolve escalations on denied and unpaid claims.Collaborate with healthcare providers, payors, and business partners to ensure revenue best practices are promoted.Monitor accounts receivable and expedite the recovery of outstanding payments.Prepare regular reports on refunds, under/over payments.Stay updated on changes in healthcare regulations and coding guidelines. NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position.Other Essential Tasks/Responsibilities/AbilitiesMust be consistent with Femwell's core values. Excellent verbal and written communication skills. Professional and tactful interpersonal skills with the ability to interact with a variety of personalities.Excellent organizational skills and attention to detail.Excellent time management skills with proven ability to meet deadlines and work under pressure.Ability to manage and prioritize multiple projects and tasks efficiently.Must demonstrate commitment to high professional ethical standards and a diverse workplace.Must have excellent listening skills.Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures.Must maintain compliance with all personnel policies and procedures.Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members.Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position. Education, Experience, Skills, and RequirementsBachelor's degree preferred.Minimum of 2 years of experience in medical billing, coding, revenue cycle or practice management.Strong knowledge of healthcare regulations and insurance processes.Knowledgeable in change control.Proficiency with healthcare billing software and electronic health records (EHR).Knowledge of HIPAA Security preferred.Hybrid rotation schedule and/or onsite as needed. Medical coding (ICD-10, CPT, HCPCS)Claims management (X12)Revenue cycle managementDenials managementInsurance verificationData analysisCompliance knowledgeComprehensive understanding of provider reimbursement methodologiesBilling software proficiency

Created: 2025-09-26