SME

Responsibilities:

• Act as a primary source of knowledge for the RCM process, providing guidance and direction to the RCM team.
• Analyze revenue cycle trends and work towards improving and streamlining processes.
• Train team members on updated RCM procedures and guidelines.
• Participate in client meetings to provide expert insight into the RCM process.
• Resolve complex RCM issues that are escalated from team members.
• Develop and maintain documentation of RCM procedures and guidelines.
• Stay informed on changes in healthcare regulations, medical coding, and billing practices.
• Collaborate with other departments to ensure the integrity of the RCM process.
• Recommend process improvements to increase accuracy, efficiency, and revenue.
• Ensure compliance with state and federal regulations as well as company policies.

Qualifications:

• Bachelor's degree in Business, Healthcare Management, or a related field.
• Minimum of 5 years of experience in healthcare RCM, with a proven track record in a similar role.
• Comprehensive knowledge of medical terminology, CPT, ICD-10, and HCPCS coding.
• In-depth understanding of medical billing, coding, collections, and payment posting processes.
• Excellent analytical and problem-solving skills.
• Strong communication skills, both verbal and written.
• Proficient in MS Office Suite and medical billing software.
• Experience in providing training and mentoring to team members.
• Understanding of state and federal healthcare regulations, including HIPAA.
• Ability to work independently, manage time effectively, and make decisions under pressure.
• Certification in medical billing or coding, such as CPC, is a plus.