RCM OPERATIONS SPECIALIST

PSN Services LLC•Plano, TX

21h

About The Position

The RCM Operations Specialist will serve as a critical operational hub within the revenue cycle team, supporting surgical hospital and ambulatory surgery center (ASC) operations across Legent Healthcare’s spine, orthopedic, ENT, and pain management service lines. This hybrid role spans billing operations, claims processing, payment posting, patient financial engagement, and front-end payment resolution—ensuring clean claims go out the door, payments are posted accurately, patient balances are collected proactively, and routine payment discrepancies are resolved before escalation. The ideal candidate combines technical billing expertise with strong patient-facing financial engagement skills. They will oversee charge validation, claims transmission through clearinghouses, and payment posting workflows while also driving early out collection strategies, point-of-service collections, and compassionate patient communication. This role collaborates closely with AR Specialists on escalated denial issues and works hand-in-hand with coding, patient access, financial counseling, and clinical teams to keep revenue flowing from charge capture through final payment. Advanced proficiency in CPSI/TruBridge, HST Pathways, and professional-level experience with Waystar revenue cycle management systems is required.

Requirements

Working knowledge of medical coding (CPT, ICD-10, HCPCS), modifiers, insurance EOBs, and patient responsibility calculations.
Strong understanding of front-end revenue cycle processes including point-of-service collections, pre-service financial clearance, and payment plan administration.
Excellent interpersonal skills with the ability to have sensitive financial conversations with patients with empathy and professionalism.
Strong analytical and problem-solving capabilities—ability to interpret collection data, identify trends, and implement data-driven process improvements.
Proficiency with Microsoft Office Suite, payer portals, patient engagement platforms, and automated payment systems.
Excellent verbal and written communication skills; ability to develop patient-facing scripts, letters, and training materials.
Experience in surgical facilities or specialty practices with high-dollar spine, orthopedic, ENT, or pain management procedures.
Minimum 3–5 years of healthcare revenue cycle experience spanning billing operations, payment posting, and patient collections—preferably in a surgical facility setting (ASC or hospital outpatient).
Advanced proficiency with CPSI/TruBridge, HST Pathways, and professional-level experience with Waystar revenue cycle management systems.
Proven experience with claims processing, clearinghouse management, ERA/EOB payment posting, and cash reconciliation workflows.
Demonstrated success improving patient collection rates, reducing AR days, and managing early out programs or vendor relationships.

Nice To Haves

Experience with patient statement vendors, multi-channel communication platforms, and automated dialer systems, preferred.
Knowledge of self-pay scoring models, segmentation strategies, and propensity-to-pay modeling, preferred.
Experience implementing patient financing programs (CareCredit, AccessOne, or similar), preferred.
Certification in Healthcare Financial Management (CHFP) or Revenue Cycle (CRCR), preferred.
Bilingual (English/Spanish) to communicate with diverse patient populations, preferred.

Responsibilities

Patient AR Management & Early Out Collections
Oversee early out program effectiveness—monitor and optimize patient collection strategies within the first 120 days of service to prevent progression to bad debt.
Manage patient AR aging buckets (0–30, 31–60, 61–90 days); implement tiered follow-up protocols based on balance size, payment history, and procedure type.
Coordinate with third-party early out vendors on performance, compliance, and workflow optimization.
Implement propensity-to-pay scoring to prioritize accounts based on likelihood of payment; create balance-based collection strategies for small (<$500) vs. large balance accounts.
Develop escalation pathways with clear protocols for when to offer payment plans, prompt pay discounts, or financial assistance referrals.
Patient Communication & Financial Engagement
Ensure timely statement generation with first statements issued within 5 days of claim adjudication; work with vendors to create clear, patient-friendly billing statements.
Implement multi-channel communication strategies utilizing text, email, phone, and portal messaging for patient outreach and automated reminder campaigns.
Manage payment plan programs including automated setup and monitoring; coordinate prompt pay discount programs and track utilization and revenue impact.
Process financial assistance applications and coordinate with third-party financing vendors (CareCredit, AccessOne, or similar); monitor charity care and presumptive eligibility screening.
Design compassionate collection scripts that balance revenue needs with patient sensitivity; coordinate warm handoffs to financial counselors for high-balance accounts.
Claims Processing & Clearinghouse Management
Submit claims electronically through clearinghouses to commercial, Medicare, and Medicaid payers; monitor transmission reports and resolve transmission errors promptly.
Handle claim rejections and edits at the clearinghouse level before transmission to payers; process initial claim corrections and resubmissions through clearinghouse systems.
Track claim status from submission through adjudication; manage claim edits, rejections, and clearinghouse error resolution.
Track and report rejection trends and initial resolution rates; escalate complex denial patterns and unresolved payment issues to AR Specialists for advanced resolution.
Payment Posting & Cash Management
Post payments accurately from electronic remittance advice (ERA) and paper EOBs; maintain payment posting accuracy above 99%.
Reconcile daily cash receipts and identify payment variances; research and resolve unidentified payments from insurance and patient sources.
Process contractual adjustments, write-offs, and refunds according to established procedures; coordinate with patient access and billing teams to locate appropriate accounts.
Ensure timely clearing of payment suspense items to support accurate month-end financial reporting; generate and analyze payment reports for management review.
Payment Resolution & Front-End Claims Management
Research and resolve payment discrepancies, short payments, and routine claim issues; communicate with insurance companies for basic claim status inquiries.
Perform initial root cause review on claim denials—reviewing EOBs, payer denial data, and CARC/RARC codes—to determine if issues can be resolved at the front end or require escalation to the AR Specialist.
Maintain detailed documentation of all front-end resolution activities; escalate complex denials, underpayment patterns, and appeals requiring advanced payer negotiation to AR Specialists.
Coordinate with billing vendors by communicating insights, denial issues, and documentation needs to facilitate corrected claim resubmission.
Reporting, Analytics & System Management
Utilize CPSI/TruBridge, HST Pathways, and Waystar platforms for daily workflow management; maintain data integrity across all revenue cycle systems.
Track key performance indicators including patient collection rate, POS collection rate, statement-to-payment conversion, clean claim rate, AR aging, and denial rates.
Analyze payment patterns and collection data to identify optimal timing, methods, and process improvements for both insurance and patient engagement.
Generate and present reports for leadership on early out program ROI, vendor performance, rejection trends, and cash management metrics.
Support system upgrades, implementations, and integration projects; create custom reports to support operational decision-making.
Compliance & Cross-Functional Collaboration
Ensure compliance with HIPAA, No Surprises Act, Fair Debt Collection Practices Act (FDCPA), payer regulations, and internal audit standards.
Partner with Patient Access teams on upfront collections and estimates; work with Insurance Verification on patient responsibility calculations.
Collaborate cross-functionally with AR Specialists, coding teams, clinical staff, customer service, and IT on workflow optimization, portal enhancements, and automation initiatives.
Participate in quality improvement initiatives and provide support for internal and external audits with documentation and data.