Senior RCM Process Specialist

ModMed is hiring a Senior RCM Process Specialist to optimize revenue cycle management workflows and systems within a healthcare technology company that focuses on AI-enabled, specialty-specific cloud platforms for healthcare providers.

Location: United States

Responsibilities

• Conduct in-depth analysis of existing RCM processes across various stages, including patient registration, charge entry, claims submission, payment posting, denial management, and accounts receivable follow-up.
• Identify bottlenecks, inefficiencies, and compliance risks within RCM workflows and propose data-driven solutions.
• Develop and implement process improvements, standard operating procedures (SOPs), and best practices to enhance RCM performance and maximize revenue.
• Collaborate with cross-functional teams, including product development, client success, and operations, to integrate process changes and system enhancements.
• Design and deliver training programs for internal teams and clients on new RCM processes and system functionalities.
• Monitor key RCM performance indicators (KPIs) and provide regular reports on process effectiveness and areas for further optimization.
• Stay abreast of industry trends, regulatory changes, and technological advancements in RCM to ensure Modernizing Medicine's solutions remain competitive and compliant.
• Participate in client-facing discussions to understand RCM challenges and provide expert guidance on process improvements.
• Assist in the development and documentation of RCM product requirements based on process analysis and client feedback.
• Troubleshoot complex RCM issues and provide advanced support to internal teams and clients.

Requirements

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field.
• Minimum of 5 years of progressive experience in Revenue Cycle Management, with a focus on process analysis and improvement.
• Strong understanding of healthcare billing, coding (CPT, ICD-10, HCPCS), claims processing, and denial management.
• Proven experience in identifying process inefficiencies and implementing effective solutions.
• Excellent analytical, problem-solving, and critical thinking skills.
• Proficiency in RCM software and electronic health record (EHR) systems; experience with Modernizing Medicine's products is a plus.
• Strong communication (written and verbal) and interpersonal skills, with the ability to effectively interact with all levels of staff and clients.
• Ability to work independently and as part of a team in a fast-paced, dynamic environment.
• Project management experience or familiarity with project management methodologies is desirable.
• Certification in healthcare revenue cycle (e.g., CRCR, CHFP) is a plus.

Benefits

• Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution.
• 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.
• Generous Paid Time Off and Paid Parental Leave programs.
• Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs.
• Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed.
• Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning.
• Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles.
• Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.