Job Search Results for Revenue Cycle Management

Principal RCM Specialist & Sales Engineer

A client of Insight Global in headquartered in Austin, TX is seeking an elite and passionate SME in Revenue Cycle Management (RCM) to become part of their dynamic team, working alongside... More forward-thinking C-suite executives, and spearheading impactful, transformative solutions. Thoughtful AI is a trailblazing Series A startup at the forefront of revolutionizing healthcare operations through unparalleled AI solutions for all things Revenue Cycle Management (RCM). This (RCM) SME will be responsible in leading the efforts to help refine, implement, and optimize current as well as future offerings. The technology arsenal includes Fully Human Capable AI Agents driven by Robotic Process Automation, Optical Character Recognition, Natural Language Processing, and Large Language Models, working together to deliver results for RCM departments. A key candidate shines in presentations and possesses analytical and financial acumen for costing and calculating ROI. This person will be a true customer advocate, orchestrating, coordinating, and collaborating across multiple departments to deliver a white-glove experience in any way they can. Beyond technical skills, this role demands a visionary mindset; Therefore, the right candidate will be comfortable speaking about AI technologies (RPA, NLP, LLM, OCR) and capable of articulating strategic solutions from a macro perspective to potential clients and articulate the customer needs to the tech team to deliver quality solutions.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .Less

Priority Claims Specialist III

Principal Duties and Responsibilities (Essential Functions): * Retrieve and properly identify any document received from Revenue Cycle Management (RCM) system * Update tracking and billing... More systems accordingly * Perform internal and external data, files, or medical chart reviews to assure that codes billed are appropriate and supported by documentation in the records and comply with Centers for Medicare and Medicaid Services (CMS) guidelines and medical policies * Complete, review, and research any deficiency to ensure that any deficiency is properly addressed * Consult with physicians / clinicians and their staff (if acceptable within the Region), as needed, on documentation issues, and other regulatory issues as they arise * Develop and manage relationships with colleagues in a professional - Responsible for conducting special projects, which may include reconciling and reviewing medical necessity, as necessary. Special projects may require spreadsheet development as well as reports that summarize outcome of special projects * Report anomalies and new trends immediately to Supervisor for additional input. Reimbursement Specialist * Prepare complex claims reimbursement submissions in a managed care environment * Assess complex claims to determine risk of denial, audit, and/or retraction * Serve as an advocate and resource to clinic administration in the areas of reimbursement and managed care * Conduct analytical research and provide expertise on items; such as; pricing, reimbursement, and claim appeals process * Maintain and support relationships with customers and insurance/managed care organizations to ensure a successful reimbursement program * Work closely with field staff and may provide training on relevant reimbursement issues * Process complex claims with a high degree of accuracy We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .Less

Contract Specialist

An Insight Global client is looking for a contract specialist to work in Columbus but also open to remote candidates. This person will be responsible for accurate and timely maintenance of critical... More provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. 50% of their day will consist of outbound calls and the other 50% will be following up with internal customers. This person will be responsible for negotiating assigned contracts and letters of agreements with hospitals, physician groups and ancillary providers that result in high quality, cost effective and marketable providers.Maintains tracking system and publish reports according to departmental procedures. Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments. Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. Identified as contract system lead by developing and maintaining provider contracts in EMPTORIS contract management software. Assists Manager and/or Director in the completion of Block Transfer Filings Facilitates and resolves claim and configuration issues with impacted departments. Participates in other contracting related special projects as directed. Supports network development throughout state to including researching, recruiting and negotiating with providers. Participates in the evaluation of provider network and implementation of strategic plans to meet Molina's network adequacy standards. Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided, and other information needed to complete the contract profile. Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes. Travels regularly throughout designated regions to meet targeted needs. Communicates proactively with other departments in order to ensure effective and efficient business results. Trains and monitors newly hired Contract Specialist(s). Participates in other contracting related special projects as directed.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .Less