RCM Systems Administrator

Palmetto Infusion Careers•Birmingham, AL

About The Position

The RCM Systems Administrator oversees Revenue Cycle system administration, payer configuration, fee schedules, reimbursement setup, and payer portal management to support accurate billing and reimbursement operations. The role ensures that configurations reflect contractual and regulatory requirements, oversees testing and quality controls, identifies reimbursement and configuration discrepancies, and partners with internal teams and external vendors on system enhancements, automation, and workflow improvements. The position also supports audits, payer reviews, revenue integrity initiatives, and inquiries involving payer configuration and reimbursement. It maintains system and portal configurations, administrative controls, documentation, training materials, and user guidance. Employees must protect confidential health information and follow HIPAA policies.

Requirements

High school diploma or equivalent.
At least 3 years of progressively responsible experience in healthcare Revenue Cycle systems, payer configuration, reimbursement, system administration, billing operations, or a related function.
Proficiency with partner programs such as MS Outlook, Word, and Excel.
Ability to cope calmly with an ambiguous, changing environment while under pressure.
Ability to work as a team member and develop productive, cooperative working relationships with all members of the Palmetto Infusion team.

Responsibilities

Oversee the creation, configuration, maintenance, and validation of payer records and reimbursement structures, including fee schedules, rates, billing codes, modifiers, locations, plan types, effective dates, and payer-specific requirements.
Review payer contracts, amendments, rate notifications, regulatory updates, and reimbursement documentation to identify required system changes and implement updates accurately and promptly.
Maintain reimbursement rates for professional services, infusion services, medications, supplies, and other billable services using applicable contractual terms and published reimbursement methodologies.
Perform and oversee quality assurance reviews, validation, and pre-production testing to confirm system and fee schedule changes are accurate, approved, documented, and implemented before release.
Analyze expected versus actual reimbursement, research payment variances, identify potential underpayments or configuration issues, and coordinate resolution with Revenue Cycle and operational partners.
Support internal audits, payer reviews, revenue integrity initiatives, and reimbursement inquiries involving payer configuration, fee schedules, reimbursement methodologies, and Revenue Cycle system functionality.
Administer payer portals and third-party Revenue Cycle systems, including user onboarding and offboarding, access permissions, password support, periodic access reviews, and administrative controls.
Monitor and coordinate resolution of system and payer portal issues, including outages, access concerns, service requests, workflow disruptions, and barriers affecting Revenue Cycle operations.
Maintain system and portal configurations, provider and organizational information, administrative procedures, system documentation, training materials, and user guidance.
Collaborate with vendors, Information Technology, Revenue Cycle, and operational departments to implement system enhancements, integrations, configuration changes, and workflow improvements.
Identify and implement technology and automation opportunities that improve accuracy, reduce manual processes, strengthen controls, and increase Revenue Cycle efficiency.
Uphold the confidentiality of protected health information and follow HIPAA policies.