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RCM Specialist

Sapphire Digital

Sapphire Digital

Multiple locations
Posted on Thursday, June 27, 2024

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Position Overview

We're seeking a Revenue Cycle Management (RCM) Specialist who can blend technical prowess with expertise in revenue cycle management, market dynamics, Zelis products, and medical coding. Your primary goal will be to conduct thorough analyses demonstrating how Zelis products align with and advance our clients' objectives.

In this position, you'll dive deep into understanding the data landscape, determining which data sets address end-users' inquiries, and articulating how data discrepancies impact overall outcomes. Crafting templated presentations and narrative-driven data stories to clarify results and challenges will also be part of your routine. Additionally, you'll be expected to grasp the intricacies of each product's processes, pinpoint any inefficiencies, and collaborate with team members to ensure all outcomes meet production standards.

Working closely with Sales, Account Management, and supporting teams, you'll play a pivotal role in identifying and seizing new business opportunities, as well as facilitating upselling endeavors.

Key Responsibilities

  • Become knowledgeable about all Zelis product offerings supported within the role

  • Work with urgency to complete projects within or prior to SLAs/TATs

  • Work independently to upload, map, and align data sets to company processes

  • Understand and interpret business needs and/or expectations of clients and/or stakeholders to produce data driven solutions that correlate to Zelis Production outputs

  • Present results of quality control reviewed data analytics

  • Prepare and speak to SQL inquiries related to data from any stakeholder

  • Troubleshoot, validate, and update data analytics

  • Prioritize multiple projects and collaborate with team members and business/technical partners as needed for support and business needs

  • Continuously identify opportunities to create/develop reporting, visualization tools, and processes to drive efficiency, accurate results, and compelling data stories

Required Qualifications

  • 2+ years of data analysis experience with large datasets

  • 2+ years of medical revenue cycle management experience; this can include experience in billing, denials management, auditing, consulting, edit configuration, edit building, and negotiations

  • 2+ years of experience with medical coding; multispecialty experience

Preferred Qualifications

  • Ability to prioritize multiple ongoing projects and responsibilities

  • Deep medical billing and revenue cycle management industry knowledge

  • CPC or RHIA certifications may be beneficial

  • Familiarity with SQL and database table structures, or corresponding data mining experience

  • Capacity for critical and strategic thinking

  • Proficient in use of Excel, including advanced excel formulas, pivot table use and data aggregation

  • Experience in utilizing ticketing systems and data analysis platforms

#LI-RZ1

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.