RCM Contract Support Specialist
About The Position
IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1. Our delivery model is trusted by national Managed Care Organizations (MCOs), physicians and patients, positioned with over two decades of expertise as the market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services. We currently serve over 2 million lives throughout the nation and the Commonwealth of Puerto Rico. Join our team as we strive for excellence through teamwork delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care.
Requirements
- Interpret insurance contract pricing tables as well as additional business requirements.
- Translate standard business requirements into functional requirements, specified to an appropriate level of detail.
- Collaborate with system vendors, IT, and integration teams to troubleshoot configuration limitations, defects, and enhancements.
- Assess financial impact of configuration decisions and errors, ensuring alignment with revenue integrity and compliance requirements.
- Follow procedures to manage major system configuration projects, including claims business rule set up outlier management.
- Monitor payer, regulatory, and coding updates to proactively adjust system configuration as requirements evolve.
- Perform quality review of completed configuration, assess outcomes and manage remediation of any noted discrepancies.
- Collaborate with billing management team to resolve claim issues due to system configuration issues and make proper corrections.
- Provide support to the billing team and related business areas.
- Support functional areas with the creation of help sheets and training materials.
- Review data post system implementation to ensure accuracy of configuration.
- Share accountability for realization of results with process owners and assist in presentation of recommendations to stakeholders.
- Identify and analyze trends by researching and responding to claims configuration requests, problem reports, and inquiries.
- Identify areas of improvement in existing work processes, and provide recommendations.
- Monitor configuration-driven performance metrics such as denial rates, AR aging, and underpayments to evaluate effectiveness of system rules.
Responsibilities
- Lead and deliver projects related to the development and configuration of new business, insurance contracts, provider contracts, new pricing and editing.
- Manage the enhancements, compliance and system enhancements.
- Ensures that ongoing activities are performed according to established policies and procedures as well as applicable state regulations and specific contractual provisions.
- Interpret insurance contract pricing tables as well as additional business requirements.
- Translate standard business requirements into functional requirements, specified to an appropriate level of detail.
- Collaborate with system vendors, IT, and integration teams to troubleshoot configuration limitations, defects, and enhancements.
- Assess financial impact of configuration decisions and errors, ensuring alignment with revenue integrity and compliance requirements.
- Follow procedures to manage major system configuration projects, including claims business rule set up outlier management.
- Monitor payer, regulatory, and coding updates to proactively adjust system configuration as requirements evolve.
- Perform quality review of completed configuration, assess outcomes and manage remediation of any noted discrepancies.
- Collaborate with billing management team to resolve claim issues due to system configuration issues and make proper corrections.
- Provide support to the billing team and related business areas.
- Support functional areas with the creation of help sheets and training materials.
- Review data post system implementation to ensure accuracy of configuration.
- Share accountability for realization of results with process owners and assist in presentation of recommendations to stakeholders.
- Identify and analyze trends by researching and responding to claims configuration requests, problem reports, and inquiries.
- Identify areas of improvement in existing work processes, and provide recommendations.
- Monitor configuration-driven performance metrics such as denial rates, AR aging, and underpayments to evaluate effectiveness of system rules.
- All other related duties as assigned
Benefits
- Medical, Vision, Dental, Short- and Long-term insurance
- 6+ Days of Holidays Pay
- 17 days of PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Comprehensive paid training program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
