Job Summary:
The RCM Operations Specialist is responsible for ensuring that all payer configurations are accurately established in the system and that any billing issues related to payer contracts, claims submission, and payment processes are promptly resolved.
Key Responsibilities:
Payer Setup and Configuration: Accurately set up and maintain payer information within the RCM system, ensuring all insurance contracts and fee schedules are correctly entered.
Portal Setup: Ability to set up payer portals and provide privileges to the right teams
Contract Management: Ensure that payer contracts are correctly reflected in the billing system, including payment terms, coding rules, and reimbursement rates.
Billing Issue Resolution: Identify and resolve any issues related to payer billing setup, provider credentialing, coding, claims rejections, underpayments, or denials due to payer configuration errors.
Denial and Rejection Follow-Up: Work with denial management teams to address rejected claims related to payer configuration, and correct errors that prevent claims from being processed.
Education and Minimum Skill Requirements:
- Bachelor’s degree in healthcare administration, business, or a related field (Associate degree with significant relevant experience may be acceptable).
- 3+ years of experience in healthcare revenue cycle management with a strong focus on payer setup, credentialing, billing, and claims processing.
- Deep understanding of insurance billing guidelines, payer requirements, and healthcare reimbursement processes. Knowledge of CPT, ICD-10, and HCPCS coding.
- Excellent written and verbal communication skills for interfacing with payers, internal teams, and stakeholders.
What we have to offer:
At FGC+, we believe that every person yearns to fulfill their potential. “Igniting Possibility” is our brand essence, it recognizes that work can be a great catalyst for personal and professional growth. By creating an environment of support and inspiration, we enable people to realize their true capabilities and to make work a source of fulfillment and sustainable success.
We offer more than just a job; we provide a nurturing environment where work-life balance, mentorship, employee engagement, and continuous learning are the pillars of your success — not to mention a market-competitive total compensation/rewards package including:
- Competitive base pay with incentives and allowances
- Payment of all statutory government benefits
- 25 days of annual paid leave
- 13th-month pay
- Onsite medical support
- Skills and training development programs
- Employee Engagement Events
- Employee Referral Program
EEO Statement:
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Third-Party Agency Notice:
FGC+ will not accept any unsolicited resumes from any third-party recruiting agencies, either domestic or international. FGC+ nor its subsidiaries/LE’s will be responsible for any fees from the use of any unsolicited resumes either through our ATS or via electronic mail systems from any agency.
