RCM OPEX Specialist Job at Femwell Group Health, Miami, FL

N2pDRk5Hclc2VngvSzU3Q25pcDA5OFRY
  • Femwell Group Health
  • Miami, FL

Job Description

Job Summary

The RCM OPEX Specialist plays a critical role in optimizing the financial performance of healthcare organizations by ensuring that revenue cycle management processes are efficient and compliant with industry regulations. This position requires detail-oriented professionals who can navigate complex insurance claims and reimbursement processes.

Essential Job Functions

  • Manage internal and external customer communications to maximize collections and reimbursements.
  • Analyze revenue cycle data to identify trends and proactively remediate suboptimal processes.
  • Maintain fee schedule uploads in financial and practice operating systems.
  • Review and resolve escalations on denied and unpaid claims.
  • Collaborate with healthcare providers, payors, and business partners to ensure revenue best practices are promoted.
  • Monitor accounts receivable and expedite the recovery of outstanding payments.
  • Prepare regular reports on refunds, under/over payments.
  • Stay updated on changes in healthcare regulations and coding guidelines.

*NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position.

Other Essential Tasks/Responsibilities/Abilities

  • Must be consistent with Femwell’s core values.
  • Excellent verbal and written communication skills.
  • Professional and tactful interpersonal skills with the ability to interact with a variety of personalities.
  • Excellent organizational skills and attention to detail.
  • Excellent time management skills with proven ability to meet deadlines and work under pressure.
  • Ability to manage and prioritize multiple projects and tasks efficiently.
  • Must demonstrate commitment to high professional ethical standards and a diverse workplace.
  • Must have excellent listening skills.
  • Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures.
  • Must maintain compliance with all personnel policies and procedures.
  • Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members.
  • Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position.

Education, Experience, Skills, and Requirements

  • Bachelor's degree preferred.
  • Minimum of 2 years of experience in medical billing, coding, revenue cycle or practice management.
  • Strong knowledge of healthcare regulations and insurance processes.
  • Knowledgeable in change control.
  • Proficiency with healthcare billing software and electronic health records (EHR).
  • Knowledge of HIPAA Security preferred.
  • Hybrid rotation schedule and/or onsite as needed.
  • Medical coding (ICD-10, CPT, HCPCS)
  • Claims management (X12)
  • Revenue cycle management
  • Denials management
  • Insurance verification
  • Data analysis
  • Compliance knowledge
  • Comprehensive understanding of provider reimbursement methodologies
  • Billing software proficiency

Job Tags

Work at office, Local area,

Similar Jobs

Taurus Industrial Group, LLC

Operations Coordinator Job at Taurus Industrial Group, LLC

 ...The Operations Coordinator for Specialty Services at our New Jersey (Rockaway) provides...  ...for maintaining OEM production schedules, managing work-in-progress within the Machine Shop...  ...technical and administrative aspects of service delivery, and contributing to the overall growth... 

Your Favorite Lenders

Entry Level Finance Sales to Loan Officer Career Job at Your Favorite Lenders

This role is for driven competitive sales professionals who want a real career in finance not a disposable sales job. At Your Favorite Lenders we do not throw you on the phones and hope you figure it out. We built a structured training and promotion system to turn...

Pride Health

Patient Care Assistant Job at Pride Health

 ...coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.... 

Carney, Sandoe & Associates

Director of Enrollment Job at Carney, Sandoe & Associates

 ...Director for the 2026-2027 academic year at Kennedy International School in New York, NY. About CS&A: Our free job placement...  ..., and the Enrollment Manager is expected to work part of the summer to support ongoing admissions and re-enrollment operations. The... 

Clayco

Vice President of Digital Marketing & Design Job at Clayco

 ...projects. The Role We Want You For The Vice President of Digital Marketing & Design is a senior executive leadership role, reporting...  ..., including website development, lead generation, user experience (UX), analytics, and performance reporting. Lead the company...